CAMBRIDGESHIRE COMMUNITY SERVICES NHS TRUST BOARD DECISION NOTING DISCUSSION

Transcription

1 MEETING: CAMBRIDGESHIRE COMMUNITY SERVICES NHS TRUST BOARD AGENDA ITEM: 2 DATE: 14 JANUARY 2015 REPORT TITLE: REPORT FROM: PATIENT STORY OF MRS MARINA MCALISTER MANDY RENTON, CHIEF NURSE DECISION NOTING DISCUSSION X X Key Issues for the Board Patient story to demonstrate the work the Community Assessment and Rehabilitation Team undertakes in the community Overall the patient was both happy and satisfied with the care provided This is a reflection of how Marina presented, before she started working with us: Before the CART team became involved and Marina started working with us, she was unable to complete any tasks independently and relied heavily on her husband. Marina, previous to her operation was extremely restricted in her ability, as mobilisation was limited to her bedroom only. This became worse following her surgery and it was agreed that through the interventions of the CART team, Marina was able to start to complete activities of daily living without the assistance of her husband. Prior to CART team input, Marina was socially isolated and unable to engage with activities, or even see family members, due to her inability to leave the home, a result of her lack of mobility and pain levels. This is an example of key stages during treatment: One of the key stages during treatment was a referral to a new orthopaedic consultant. This was for specialist management in order to ensure that she was assessed holistically, and to have all aspects of her past medical history taken into account. A CCS Physiotherapist accompanied Marina to these appointments to allow conversation and discussion with the specialist to inform them of the issues that had arisen. As a result of this referral Marina was provided with a diagnosis for which she was able to receive treatment, and to enable her to manage her pain level. A further intervention was that of the physiotherapist accompanying Marina to a gym as well as to Hydrotherapy to oversee her introduction to the new approaches to help her complete exercises. Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Peterborough, Luton and Suffolk

2 This is the outcome for Marina at the end of our intervention: By the end of the treatment Marina had made significant improvements. Marina is now able to mobilise unaided. Marina is able to control her pain to be able to complete her activities of daily living. Alongside this, Marina has been able to complete her personal goals. She no longer relies on her husband as much, which allows her to be more independent and engage in social activities outside the home, which she previously was unable to complete, in addition to reducing the carers stress of her husband.. Marina is able to visit her family and has even been on holiday since her discharge from the CART team. Issues for Decision/Recommendation/Escalation Board Assurance Framework Risks scoring 10+ are automatically entered onto the BAF risk register. If this story is associated to a risk, this will be highlighted to you and/or completed by the relevant Unit Manager. CQC OUTCOMES (Please refer to the link below for the current CQC outcomes to then insert those which are relevant to this document see Quick Guide to the Essential Standards.) Page 2 of 5

3 1. PURPOSE This patient story will highlight the patient experience with CART. This story was collected 2. SERVICE BACKGROUND The Community Assessment and Rehabilitation Team (CART) is commissioned to provide rehabilitation services to promote faster recovery from illness, prevent unnecessary hospital admissions, support timely discharges and maximise independent living in the community. CART provides patient s, their relatives, carers and those round the patient with rehabilitation and advice, care and support to help them be as independent as they can be after their period of illness. The team work both within the community in their own homes and well as the Rehab unit at Moorland Gardens. The team also supports other professionals in the community who are caring for patients e.g. GPs, nursing staff, carers, social workers and voluntary organisations to ensure people get the assistance that they need. 3. CASE SUMMARY Marina is 42 years of age. Marina was referred to the Community Assessment and Rehabilitation Team in May The reason for her referral was due to elective right hip replacement on 14th May 2012 at Addenbrookes Hospital in Cambridgeshire. Marina was referred to the team by her local GP due to an administrative error at Addenbrookes where post-operative care was not organised. The patient previously had her left hip placed at Stanmore Hospital in 2009 and had multiple other Bilateral Patella Tilt, Prolapsed Lumber intervertebral disc and previous Pulmonary Embolism. Prior to treatment from the Community Assessment and Rehabilitation Team Marina was unable to mobilise and relied heavily on her husband to help with all activities of daily living. These had been long term problems that had worsened following her surgery. Marina was assessed approximately 1 week post-surgery. Following the screening process it was deemed an urgent priority to see, and assess, this lady. Prior to her hip replacement, Marina was limited in her mobility as well as having problems with pain due to her hip problems and other medical conditions. The team accessed Marina very quickly with the contracted time line, the patient was referred from GP 21st May 2012, screened by CART 22nd May 2012, and seen by physiotherapist 25th May Marina stated that she found the service fantastic and reported that the service gave her a very helpful physio. Marina stated that for her first visit she had been very scared and worried but the physio managed to calm her before addressing any physio needs which put the patient at ease. Marina felt the access and organising appointments with the service were easy to arrange and contact to the team was stress-free to complete. The patient felt complete trust in the physiotherapist that she had. The physiotherapist treated her with respect, was kind and caring very knowledgeable. Marina also reports that she feels that if the physiotherapist was unsure about anything she would always find out. Marina felt like she was looked at holistically by the physiotherapist to help with her other conditions that also were affecting her ability to achieve her personal goals. Page 3 of 5

4 Communication with physio was good, even when patient was experiencing large amounts of pain and couldn t communicate well. Although communication was difficult at times due the levels of pain Marina was experiencing, both patient and physio were able to explain and understand each other well. Marina s personal goals were aimed towards her activities of daily living. Firstly, Marina wished to be able to mobilise without aids, and at longer distances than she currently completed. One of her inter goals was to be able to complete her mobility practice to allow her to walk to pick up her niece from school, which was a short distance from her home. This is worked towards with physiotherapy and practice. The second goal was to be able to return to driving, although this goal was not fully completed due to confidence issues, Marina was able to return to driving small distances with her husband present in the car. To help with this range of movement was completed and needed. Along with increased mobility, the other main goal was that of reducing her pain levels to increase her ability to be able to complete activities of daily living. Although this was a medication issue that the physio was able to assist in by liaising closely with the patient s GP as well as advice of pain management strategies. Marina received weekly physiotherapy input to help achieve her goals. Marina advised that she was completely satisfied with the care and treatment she received as well as the outstanding work and effort given by the physiotherapist. The physiotherapist was proactive with Marina to help her achieve her goals and was able to take her time with Marina when it was needed and Marina was looked after holistically taking into account her other medical conditions. The physiotherapist introduced Marina to different treatments and aspects to help with her care and treatment. The physio tried multiple different areas to help Marina achieve her goals and brought her outside knowledge to help with the use of strapping and taping. This was in addition to attending gym sessions with the patient to give a safe and comprehensive exercise programme that would help, and not increase pain or problems, as well as including hydrotherapy into her exercise programme. The physio would find alternative problem solving when the patient was unable to complete a certain task or exercise and this was beneficial to the patient. The physiotherapist also liaised with the GP regarding Marina being referred to a new consultant who would take over all of her care regarding her medical problems, this was spoken about with both Marina and her GP thoroughly before the referral was made. The physiotherapist attended hospital consultant appointments with MM to ensure the consultant had all relevant and precise information, as well as gauge if more could be done by speaking directly with the consultant at the appointments. 4. LESSONS LEARNT From the patient s feedback of working with the team, we have learnt that although there were many positive pieces of feedback there were also some negatives. This negative feedback was regarding our communication and referral process to and from out of area hospitals. The CART team are working to achieve a better referral standard of cross organisational communication to ensure that our patient s experience a smooth and safe transitioning from acute hospitals to community services if referred by out of area hospitals. Communication was key with Marina, it was identified that the physiotherapist that saw the patient was reassuring and was very calming on initial visit to help the patient. For the patient a holistic approach was also found to be a positive learning point that although the Page 4 of 5

5 referral may have been for a specific problem the CART team are able to look holistically at a person and help with other issues or problems that the patient may be experiencing. Ongoing access to the service during the period of treatment was again reported to be positive; Marina had the numbers to contact the team and physiotherapist. After each visit the next appointment was booked allowing patient to fit appointment in with other appointment and commitments. Learning has also come from the fact that the patient found it difficult when Marina s main physiotherapist was absent for a period of time following her own surgery and another member of the team handled Marina s case until the return of her own physiotherapist. Marina felt that the member of staff rushed appointments and was frequently late. This resulted in the patient not feeling valued and feeling that she was unable to communicate with the member of staff any issues that had arisen since her previous appointment, From this we have learnt that advance appointment booking is a good way to ensure patients are seen and rehab is completed, but also that the relationship you build with a patient is also key, these relationships are not only built around the time you spend with the patient but the promptness and appointment keeping of staff. 5. CONCLUSION By the end of the treatment Marina had made significant improvements. Marina is now is able to mobilise unaided and is now able to control her pain and complete her activities in the respect of independent daily living. Louise Armstrong Physiotherapist Community Assessment and Rehabilitation Team (CART) Page 5 of 5