Dr Alistair Lewthwaite Consultant Neurologist Dudley Group of Hospitals and Queen Elizabeth Hospital Birmingham

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1 Dr Alistair Lewthwaite Consultant Neurologist Dudley Group of Hospitals and Queen Elizabeth Hospital Birmingham

2 The Dudley PD disease team Dr Alistair Lewthwaite consultant neurologist Dr Shams Duja consultant Elderly Care physician Dr Roland Etti (Botulinum toxin therapy clinics) consultant neurologist Trudy Gaskin PD CNS Community Alison Waldron PD CNS Acute Dr Janine Barnes Neurology Specialist Pharmacist Community neurology service/team (Eva Matussekclinical psychologist)

3 Background Consultant Neurologist appointed in Dudley in June 2010 Trained in the West Midlands Specialist Interest in movement disorders PhD in Parkinson s disease genetics Deep Brain stimulation for Movement Disorders assessment clinics at QEHB

4 Dudley PD service Set up weekly PD clinic Assess current service and develop the service Dr Shams Duja, consultant elderly care physician Population Dudley 330,000 (approx 700 PD patients) Service 2010 Referrals into Neurology or Elderly Care Primary care neurology team Community PD CNS Trudy Gaskin Pharmacist with specialist interest in Parkinson s disease, Dr Janine Barnes

5 Dudley PD service Support from Dr Roland Etti as CSL, Rachael Benson as general manager Andrew Hindle as commissioner from PCT/CCG Formulary Prescribing guidelines Referral pathway

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8 Neurology Specialist Pharmacist In the management of PD Dr Janine Barnes Background in neuroscience research Neurology Specialist Pharmacist role introduced 2009 Unique role Weekly PD clinics in the community Supervisor for accreditation with Special Interest in Neurology...

9 Acute PD Nurse Specialist Service Identify need to improve quality of inpatient service Community team unable to regularly attend hospital Funding 2 year pump priming funding from Parkinson s UK Reduction in length of stay and preventing unnecessary admissions Funding agreed by trust board Steering group Alison Waldron in post for over 6 months...

10 Acute PD Nurse Specialist Service 2011/12 figures, 569 patients were admitted to DGHFT with PD If length of stay was reduced to 10 days this would equate to a financial saving of 270,000 on such inpatient stays (based on a bed day cost of 130)

11 Acute PD Nurse Specialist Service Assist those living with PD to improve quality of life by identifying and linking to appropriate care services and therapies at an early stage in their illness in order to optimise treatment and prevent unnecessary admission Provide education and training to nursing colleagues on wards, raising awareness of the particular problems faced by PD patients, such as getting medication on time, in all areas of the acute sector Suboptimal management of PD leads to a prolonged length of stay not only to bring the disease back under control, but due to the development of complications of immobility such as aspiration and thrombosis. Help anticipate and prevent these problems Support nursing colleagues on the ward by assisting in monitoring the response to medication changes and adjusting medication within agreed protocols. Length of stay can be prolonged if PD patients are prescribed inappropriate medications. Liaison and education supplied by PD CNS can prevent this Crucial role in discharge planning, liaising with the key services to ensure safe discharge and reduce readmission rates Correlate relevant information on the patient, such as recent OP appointment information and also any interactions with community teams. Complete full assessment of the patient and document a plan of care in the notes. Participate and be responsible for monitoring day case Apomorphine challenges, telephone helpline, audit and research activity

12 Acute PD Nurse Specialist Service Patient identification/reviews It system Referrals Attendance in EAU Get it on time Staff education Nil by mouth treatment guidelines in PD patients Extensive previous neuroscience/pd background has been very helpful

13 Parkinson s Disease Specialist Nurse (Acute) Monthly Stats March 2014 Number of patients seen: 42 (33 New patients) Total face to face contacts: 98 Average face to face contacts per patient: 2.4 Total non face to face contacts: 1 Clinical areas referred from: C1 1, B6 2, C6 1, CCU 1, C8 7, PCCU 1, A3 1, A4 2, EAU 6, B2 3, ED 1, B4 4, CDU 3 Referred by: Medical Handover 4, Impact 2, AHP s 8, Specialist Nurses 4, Ward Staff 1, medical Staff 1, database 13 Outcome: Remains an in patient 11, Hospital transfer 1, Home 19, RIP 2 Reduction in length of stay

14 Acute PD Nurse Specialist Service further developments Hot clinics with EAU team Identification and assessment of any PD patients who are regular A&E attenders/regularly admitted IT system/database to allow seamless working between acute and community PD teams Patient/service satisfaction surveys Independent prescriber

15 Future developments in Dudley PD service An additional community PD CNS Pump priming from Parkinson s UK 3 PD CNS posts to create fully integrated service Dudley Apomorphine service

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