Hospital Liaison Team

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Hospital Liaison Team

JULIE MATTHEWS, SENIOR NURSE MANAGER MAGZ SMITH,
SUPPORT WORKER
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PRIMARY ROLE

• TO PROVIDE -
• ASSESSMENT
• SUPPORT
• ADVICE
• LIAISON
• FOR PEOPLE WITH A LEARNING DISABILITY WHO NEED TO
  ACCESS
• ACUTE GENERAL HOSPITALS FOR -
• ADMSISSION
• INVESTIGATION S
• TREATMENT
• FOLLOWING THE PATIENT JOURNEY THROUGH TO THEIR
  DISCHARGE

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BACKGROUND / WHY WE ARE NEEDED/EVIDENCE

• Health inequalities.
• Access to care.
• Unmet health needs.
• (DH 2001, Mencap
  2007, DRC, 2007)

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TREAT ME RIGHT

• Mencap
• 2004
• Poor treatment
• Views of medical profession
• 
  (Mencap 2004)

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DEATH BY INDIFFERENCE

• Mencap
• 2007
• Ombudsman
• Independent enquiry
• Awaiting Government response
• (Mencap 2004,
  2007)

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CASE STUDY

• Female
• 65yrs
• Hospital 2 weeks
• Informed by Clinical Case Managers
• Choking episodes/aspirate event/chest infection
• History of -

• Gall Stones
• Constipation
• Aspiration
• Weight Loss
• Requested urgent Case Conference
• Patient died
• P.M Concluded cause of death perforated bowel and
  Cerebral Palsy

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EDUCATION(ESTABLISH TRAINING NEEDS)

• Provision of a training needs analysis
• Audit to be undertaken
• To partake in the induction training programme
  for all new WWL staff
• Provision of training for Social Care, Voluntary
  and Private Provider Services

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PATHWAY

• Determine if referred client meets
  criteria/eligibility
• Accept or decline referral
• Complete 2 minute risk assessment
• Look at capacity
• Collate client history
• Make any onward referrals (psychology/SALT)
• Pre-Operative work (accessible format for planned
  surgery)
• Desensitisation if required

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PATHWAY

• Complete Hospital document with client and or
  carer
• Liaise with ward staff regarding planned
  admissions
• Visit client on ward/Clinical decision unit if
  team is notified of an emergency admission
• Ensure an appropriate advocate is in attendance
  at ward rounds
• IMCA representation if capacity to retain
  information is lacking and no family or friends
  involved with patient

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CONTINUED

• Access medical notes when needed
• Ensure staff have access to patient hospital
  document
• Attend any needed MDTS, case conferences and
  discharge planning meetings
• Ensure referrals to other LD nurses are made in
  advance if staff training is required to support
  client on discharge

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ROLES AND RESPONSIBILITIES

• Attendance at discharge planning meetings for all
  people with a learning disability who are
  regarded as requiring complex care.
• To request additional meetings for those people
  whos needs have changed and thus future care
  package may be affected.
• To work jointly when required with the other
  Nurses within Learning Disability Services if a
  client held on their case load is admitted to
  hospital

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AIMS AND OBJECTIVES

• Establish good links with Pharmacy around
  medication prescribing/ stock issues
• To look at Acute Service Nursing Admissions
  Assessment and discharge process
• Identify funding streams for extra support for
  patients with complex health needs.
• To develop a care pathway/protocol with hospital
  SALT colleagues to minimise the risks that
  dysphagic patients experience

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CONTINUED

• To inform the Divisional Chair within medicine of
  the teams role and plan to attend the consultants
  monthly meetings to present the teams role and
  function.
• To meet with the Head of Nursing within medicine.
• To establish a steering group to help in the
  development process of the team
• To have training and access to WWL Trusts
  Electronic Patient Record System (EPR) and
  Patient Administration System (PAS) system.

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INVOLVE OUR PATIENTS/CLIENTSTHE PATIENT
EXPERIENCE

• Establish local views around hospital admissions
  for people with learning disabilities through the
  LD partnership board
• Hospital document to be placed on partnership
  board website and accessed by anyone. Feedback
  around its use to be sought through the sites
  chat room forum
• Feedback into the Trusts patient focus groups
• and PPI group.

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END OF LIFEPREFERRED PLACE OF CARE

• To ensure that clients who are at the End Of Life
  have a Care Of The Dying Pathway in place, and
  their needs and wishes are adhered to during the
  end stages of life.
• To ensure that any DNAR orders are discussed and
  recorded with relevant people and are reviewed
  according to policy

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DEVELOPMENTS TO DATE

• Provision of a hand held Patient Document which
  details health and social needs, and addresses
  safety whilst the person is in hospital
• Forged links with the Director Of Nursing within
  Acute Services.
• Building of relationships with Clinical Case
  Managers, Specialist Teams, Ward Managers,
  Clinical Governance Leads
• Liaison with other Professionals to establish
  future working relationships and Care Pathway
  Development.
• Liaised with the LD IMCA around capacity issues
  and future working. (Looking into planning joint
  training for professionals and our care-pathway
  approach for people requiring serious medical
  interventions)

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CONTINUED

• Presented at Ward Managers Meetings.
• Invited to The Acute Trust Patient Focus Forum.
• Verbal and written agreement between WWLs
  Director Of Nursing and the PCT for the Senior
  Nurse to write in patients Medical Notes.
• Development and piloting of a capacity assessment

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CONTINUED

• Met with the communications/patient safety rep
  (Talking with Patients).
• Arranged to meet with the head of unscheduled
  care
• Requested to have membership on the PPI group
• Meeting held with Clinical Governance
  Facilitators Surgical and musculoskeletal
  Directorate)
• Planned meeting with IT to look at a flagging up
  system within triage to identify people with a LD
  who are admitted in an emergency

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PAPERWORK

• Draft eligibility tool
• Draft Operational Policy.
• Draft Criteria For Referral.
• Draft Patient and Professional Leaflets
  completed.
• Accessible hospital document.
• Draft capacity assessment tool.

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PROMOTING THE TEAM

• Stall held at the hospital during health week
• Email sent to communications department regarding
  the team
• Flyer designed and submitted to the hospitals
  monthly focus magazine
• Posters designed for all consultation rooms,
  out-patients department A and E, Wards and the
  Walk-in-centre.
• Met with the GP Quality Group, and leaflets about
  the team to be sent to practices once ratified.
• Article to be written and placed in GP news
  letter and practice nurses news letter

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AWARDS

• Entered the team for a PCT award
• We are invited to the awards presentation this
  evening

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FUTURE DEVELOPMENTS AHEAD. (SIX TO TWELVE
MONTHS TIME)

• A review of client data base to look at the types
  of admissions, times of year, ages, demographics
  etc, feedback to Public Health
• A robust Care Pathway for planned and emergency
  admissions that will be agreed by all
  Stakeholders.
• A qualitative piece of research with Edge Hill
  University around hospital admissions for people
  who have a LD. Process in the very early stages

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ANTICIPATED PROBLEMS

• No one in post as a clinical governance lead
  within medicine
• More problems within general medicine than within
  surgery
• Staff too busy
• Many difficulties due to working in separate
  Trusts
• Staff ignorance, lack of training and releasing
  to have training.

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CONCLUSION

• The teams roles and responsibilities will be
  adjusted according to developments.
• We will review the approach in April 2008
• We would appreciate any positive comments or
  constructive advice during the development stage.

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THIS IS THE END..But to us this is only the
beginning

• THANK-YOU FOR LISTENING
• ANY QUESTONS?