Feature: Bringing care closer to you
Ten years ago, The Walton Centre was one of a few specialist NHS Trusts tasked with revolutionising neurological care for patients. From this work came an innovative project, which would enable staff to bring the high quality care patients receive in hospital to patients closer to home. The Integrated Neurology Nurse Service (INNS) was born.
This team of specialist nurses goes out into the communities where our patients live, so that they don’t have to travel long, sometimes anxious, journeys into the hospital for care and support. People with long-term neurological conditions, such as motor neurone disease, multiple sclerosis, Parkinson’s disease and epilepsy qualify for this service.
Advanced Neurology Nurse Louise Fasting (right) is one of the INNS team. She said: “We’re a six-strong team, supporting patients through a number of different ways. From community clinics and education to home visits and providing a telephone support line, we work hard to support patients who are trying to live well with their conditions.
“What we’ve found over the years is how useful the service is to this patient group. No two days are the same, and that certainly keeps you on your toes! With a lot of our long term neurological patients, they need that reassurance and support that their condition is being managed – and we can provide that reassurance, without them sometimes making an arduous journey to their clinician here at The Walton Centre.
“The team and I can provide a specialist link to The Walton Centre within their local communities, bridging the gap between primary and secondary care. It’s also important to note the way we strive to integrate patients into community support systems and local healthcare systems.”
Timeline of a typical INNS Nurse day
8.30am: Arrive at community clinic.
9am: First patient arrives with epilepsy, seizures are stable but prevalent issue is low mood. Signposted to local services and talking therapies.
9.30am: Another person living with epilepsy. Meds increase needed.
10-11am: Two stable Parkinson’s patients, signposted to local exercise groups and a referral to physiotherapy.
11am: A person with Huntington’s disease, multiple issues identified. Left with a plan to refer to neuropsychiatry, social services, and
occupational therapy.
11.30: A person with multiple sclerosis who has found worsening mobility. Full assessment completed and a referral to physiotherapy required.
12:00: Last clinic patient. A person with Parkinson’s disease, some adjustments required to medication regime and lifestyle advice provided.
12.30-1.30pm: Dictate clinic and a bite to eat.
1.45pm: First home visit is a patient with epilepsy who struggles with remote consults and clinic attendance.
2.30pm: Second home visit, joint visit with a community matron for a person with progressive supra nuclear palsy, having issues with swallowing.
3.45pm: Last home visit, a person with motor neurone disease. Full assessment given, issues identified, and advice given to GP.
Read Feature: Bringing care closer to you…
The image guidance machine uses scan data, which will allows surgeons to know where in relation to the patient’s scan they are on the head. To test it requires the correct scan sequences. More Walton Centre staff, Neuroradiologists Dr Samantha Mills and Dr Kumar Das provided support in setting this up. A volunteer (A University student) was procured to have a test scan that could be used to demonstrate the machine. The generator was switched on, as the hospital runs on solar power, and the MRI needs consistent power. The first ever volume scan was then performed on this scanner to be used for image guidance.
Jonathan McGregor, Research Management and Governance Lead
Dr Charlotte Dougan, Consultant Neurologist
Emma Baldock, Resuscitation Lead/ANP, Acute Response Team
Cathy Stoneley, Advanced Nurse Practitioner
Graham said: “It was a lot of information to take in a short time. I had the family around me, but I think we were all in a bit of shock. I was not well, so finding out what was going on quickly was key for all of us.”
As with any surgical procedure, pre-operative assessments are carried out which are tailored to the patient and the procedure they are scheduled to have. Approximately 70 pre-op assessments are carried out at The Walton Centre every week.
On the morning of their surgery, the majority of patients will report to Jefferson Ward. It’s here that all the pre-op measures that were outlined will be doublechecked, confirming that it is still safe to carry out the surgery. Unless they have been admitted the night before, all patients undergoing elective surgery start their journey in Jefferson Ward.
Forward wait, where patients arrive just before heading in for their operation, is a bustling area first thing in the morning. Many of the day’s surgery patients will be waiting here before heading for their designated theatre.
operating theatres. Here they are looked after while they wake up from their anaesthetic.
Ward Manager Abbie Birch said: “The lovely team on Cairns Ward not only supports patients after their surgery but also gets them well enough to leave and recover at home. It can be here on the ward where clinicians can assess whether the surgery has had the desired effect, so helping patients feel as well as possible is really important.