How to Integrate Continence Services and Secondary Care to Develop Pathways of Care.

Transcription

1 How to Integrate Continence Services and Secondary Care to Develop Pathways of Care. Jenny Stuart. RGN, Post Reg Dip Nursing, Bmidwif (Hons), NMP, PG Dip. Continence Service Lead Community and Integrated Services

2 History Tier 2 Continence Services 2004 commissioned. Aim To see patients suffering with continence problems in the community rather than them being sent to secondary care.

3 Stress Urgency Frequency Nocturia Incontinence Key words Referrals triaged every week with booking- No consultant involvement or communication at this time.

4 Urogynaecology First to engage Lead to Monthly MDT meetings Referrals sent back to primary care for conservative treatment. Direct referral pathway back to secondary care if conservative treatments failed

5 Urology Excellent relationships: Lead Urology Nurse Minimal communication with Urologists (initially) Improved with recruitment of new c Consultant Direct communication Direct referral pathways Pathways developed to ensure NICE compliant.

6 Joint MDT meetings with: Urogynaecology Urology Resulting in.. Development of more formalised pathway for women suffering with incontinence

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8 Next Steps.. Commissioned Services such as: Male Lower Urinary Tract Clinics NICE Guidance 2010 Any qualified provider

9 Clincal skills: Flow rates Post void scans Clinicians already had Analysis of IPSS scores Prescribing Non medical independent prescribing

10 Additional Training Required DRE training 100 DRE s with consultant urologist in 2 week prostate cancer clinic. Continued with clinical supervision on a monthly basis Urological Consultant

11 Benefits for the Patients Assessed closer to home Assessed within one week of referral into the service In-depth consultation Majority of patients managed in primary care Trusted assessment if referral to secondary care required (avoids duplication)

12 Two week wait cancer referral if PSA > 4 in absence of positive urine or if symptoms suggest 0-7 Mild Conservative/lifestyle advise Primary care follow up Better Male LUTs Refer to community LUTs clinic History (NB Endocrine, Cardiac) IPSS DRE Flow rate IPSS score PSA if appropriate 8-18 IPSS Moderate Severe Alpha blocker +/- 5x Both reductase inhibitor (if moderate to large on DRE. Re evaluate in 2-3 months Re evaluate 6/52 No Change Consider Urology Male Luts Pathway Worse? AUR Refer Urology J Stuart Continence Nurse Specialist J Calleary Consultant Urologist 2012 Reviewed Feb 2016.

13 Continence Prescription Service All continence products prescribed on FP10 by the Continence Service Trial without catheters carried out in the community to prevent patients having to attend as a day case admission saving on tariff Promote self care ISC self dilatation Nephrostomy Catheter related problems in the community. Referral/communication with urology

14 Further Developments Triage all: General Practitioner urology referrals Integrated Care Pathway Governance Lead Consultant Urologist

15 Stoma care. In Addition All new stoma patients seen within 3 days of discharge. Seamless service for patients Excellent communication with hospital based stoma nurses

16 Positives Factors influencing integration: Communication Trust Patient satisfaction Referral pathways Proactive approach

17 Challenges? Not commissioned to work in secondary care and visa versa Resistance that community service was taking some work from secondary care Overcome this by.

18 Future Developments Collaborative working with: Geriatricians Colorectal Team To develop care pathways and referral criteria Continue to maintain and build on: Existing urology and urogynaecology integration with future organisational changes.

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