The National Spinal Injuries Centre – Adult Scope of Practice

The National Spinal Injuries Centre- Adult Scope of Practice

The National Spinal Cord Injury Centre (NSIC) at Stoke Mandeville Hospital provides specialised, coordinated, interdisciplinary, medical and rehabilitation care which is outcome focused and patient centred serving the unique needs of people with spinal cord dysfunction. The service is needs based and not age discriminatory. There is a dedicated young person’s unit for Spinal Cord Injured young people and ongoing work to address the specific needs of the older adult.

Mission:

The NSIC assists people with functional limitations, of all ages, to achieve realistic goals and to reach their highest feasible level of functioning by providing a comprehensive, specialised, interdisciplinary rehabilitation service. This provides them with the skills, knowledge and information for them to return to their role in society and achieve participatory goals.

Vision:

The NSIC strives to champion and respond to the needs of all people with spinal cord impairment who need rehabilitation throughout childhood and adolescence and transition into adult spinal services.
We are committed to working with charitable and statutory organisations to promote a continuum of rehabilitative care through the delivery of high quality spinal rehabilitation services, education, and integrative sports and arts programmes.
Research and post graduate education has an existing and developing role in ensuring the NSIC is at the forefront of knowledge and strives for translational activity in these fields.

Values:

The NSIC is committed to the 5 patient promises of the Buckshealthcare Trust. These are:
1. Clean and safe practice.
2. A caring and respectful attitude from approachable teams.
3. Respect for your time with care closer to home.
4. Easy access to comfortable modern facilities, offering privacy and dignity, personal space and good healthy food.
5. The best clinical care from teams of skilled healthcare professionals.

There is also a set of service standards that staff are expected to embed in their working practice for communication between themselves, patients and staff. These are under the main headings of communication, compassion and courtesy.
We have been working with the author of a concept called “The Meaning of Careful” , an acronym that stands for principles that should assist in delivering outstanding results in healthcare by putting people before process. CAREFUL represents: Committed, Active, Responsive, Energetic, Focussed, Uniform and Leading. This approach forms a sound approach to collaborative teamwork.
We strive to be good stewards of the finances available to the service, whether as part of the contracts or donations.

Spinal System of Care:

The goal of the Spinal Cord Programme is to provide culturally sensitive, comprehensive, individualised, goal directed, inpatient rehabilitation services to individuals who have experienced a spinal cord injury or disease and
have physical impairments or activity limitations that may potentially benefit from comprehensive rehabilitation programmes throughout childhood until transition to an adult service.
The aim of the programme is to assist individuals to live within their community at their highest level of function both as child or adolescent and in adulthood.
The Spinal Cord Programme endeavours to work toward optimal effectiveness, and achieve a high level of satisfaction to users of the service, their friends and family, by providing appropriate resources as a means to work towards each individual’s goals.

Funding Sources: The programme is largely funded by NHS sources and agreements are in place for this to be consistent. Other third party payment sources are accepted where there are financial agreements within the NHS Trust.

Admission Criteria / Types Of Individuals Served:
It is the policy of the NSIC to review the criteria developed by the South East Consortium, now the NHS Commissioning Board, and the NSIC for admission to, continued stay, and discharge from the programme. Variations from these criteria can be considered, but must be supported by appropriate rationale and goals that are consistent with NSIC’s mission, vision, and values. Each individual must require and benefit from a rehabilitative hospital level of care coordinated by a rehabilitation team which includes: 24 hour availability of registered nursing; relatively intense level of interdisciplinary services with the intent/ability to achieve realistic functional goals. Once an individual no longer requires or can benefit from this level of care they will be discharged or transitioned to the next appropriate level of care. This will be monitored every 3-4 weeks through the established Goal Planning Process.

An individual who is ventilator dependent can be considered for admission for rehabilitation and training.

As admission is needs based there may be individuals with psychological, cognitive or social challenges. Appropriate assessment will be made for these people and will be admitted to address their Spinal Cord Injury needs if these can be met.

Readmissions for short stay programmes are available for those with identified goals where they cannot access services locally but are expected to benefit from  therapies such as intensive gait training; have the potential for realistic improvement from this programme as demonstrated and documented by goals with associated time frames; able to manage with medical supervision weekly, or less frequent basis, and may require nursing care.

Ages Served: Persons of all ages up to the end of the 18th year can be served by St Francis Ward young person’s service, and in the adult service be needs led, not age discriminatory. With older people it is important to establish the most appropriate approach to their needs, from a medical, rehabilitative and geographical perspective.

Medical Acuity: Individuals who have sustained a disabling condition of
recent onset, exacerbation of a pre-existing condition, or in need of a
treatment programme designed to lessen disability or dependencies, and are
likely to benefit from a comprehensive rehabilitation programme, can be admitted. Individuals must require the availability of 24 hour rehabilitation nursing care, the availability of various ancillary and diagnostic services, and medical supervision. The use of mechanical ventilation equipment is not a contraindication for this service.

Medical Stability: Individuals must be orthopaedically and haemodynamically stabilised and able to participate in, and benefit from, an intensive   rehabilitation programme.

  • Patients are admitted to the programme by a qualified Spinal Cord Injury Specialist.
  • Patients have access to a broad range of medical specialties and

subspecialties to meet all acute care needs.

Hours of Operation and types of programmes:

Inpatient Programme: The inpatient wards provides a rehabilitation environment 24 hours a day, seven days a week. Regular scheduled rehabilitation therapy sessions occur Monday through to Friday with weekends directed to the practice of rehabilitation skills. The patients and  the rehabilitation team are encouraged to set home or leisure rehabilitation goals if they are away over a weekend.

Review Programme:
Patients receive life long care from the centre once they have made a transition from the inpatient programme. If goals are identified they may be readmitted to St Joseph for follow up rehabilitation such as management of personal care or gait training for a short allocated period.

Programme Setting:
This occurs in the structured therapy setting, off site sports stadium, home environments / assessments, therapeutic arts events in the centre, therapeutic visits out of the centre and overnight leave.

Services Offered In The Spinal Cord System Of Care

The following services are provided to all individuals in the Spinal Cord System of Care:

  • Spinal Cord Injury Consultant
  • Rehabilitation Nurse
  • Occupational Therapy
  • Recreational activities – sports / arts
  • Physiotherapy, including aquatic therapy and adaptive sports programmes
  • Clinical Psychology
  • Case Management
  • Patient liaison and advocacy
  • Play Specialist (young people)
  • School Teaching  Service (young people)
  • Patient Education Programme
  • Pharmacist

Depending on the unique needs of each individual, the following services are also provided:

  • Nutrition Services
  • Speech Language Therapist
  • Psychosexual therapy
  • Chaplaincy
  • Family Counselling
  • Vocational services
  • Prosthetics/orthotics
  • Other medical or surgical consultations,
  • Adaptive technology service etc.
  • Liaison Psychiatry

Follow up visit:

Appointments after discharge from the ward are arranged for outpatients visit to clinic if needed and the outreach team can visit at home if required.

Diagnostic and screening services:

Provision is available for medical care for most medical/paediatric conditions with the exception of paediatric Intensive Care. All medical issues that may be a factor for a person with spinal cord dysfunction can be managed with consultation from various other specialists, as requested by the spinal  doctors and team.
In addition, diagnostic imaging, laboratory services and pharmacy services are available within the trust.
The NSIC provides specialist care for those with spinal cord injury and associated complications such as

  •  Autonomic dysreflexia
  •  Bowel function
  •  Bladder function
  •  Circulation
  • Cardiac Function
  • Cognition / Psychological difficulties – Mood disturbance, pre morbid mental health problems, adjustment issues, ABI, special needs, pain management.
  •  Dysphagia
  •  Fertility
  •  Medication
  • Metabolic Function
  • Musculoskeletal complications
  •  Neurological changes
  •  Nutrition
  •  Pain – acute and persistent pain
  •  Respiration
  •  Sexual function
  •  Skin integrity
  •  Spasticity

Addressing Participation and Functioning:

The NSIC is capable of addressing functional and goal directed services. An interdisciplinary core team includes Nurses, Occupational Therapists, Physiotherapists, Psychologists, etc.
All work with the patient and family to address aspects related to an individual capability to function using the goal planning process within their intended living environment.
Examples include:

  •  Activities of daily living
  •  Assistive technology
  •  Community integration
  •  Drivers potential assessment
  •  Durable Medical Equipment
  •  Emergency Preparedness
  •  Environmental Modifications
  •  Leisure and recreation
  •  Medication
  •  Mobility
  •  Orthosis/Prosthetics
  •  Personal care assistant training
  •  Seating
  •  Vocational Services
  • Educational needs

ctivity Limitations:

Individuals in this programme will have difficulty executing activities that
may include any of the following:

  •  Activities of Daily Living
  •  Self Care
  •  Mobility
  • Communication

Transition support :

All patients and their families are allocated a case manager upon admission to the programme who will assist with identifying potential difficulties with discharge transition and support people in their decision process prior to moving on from the rehabilitation environment.
A clinical psychologist is available to work with both adults, children and their families. There is a family counsellor and a patient advocate who can meet with both child and family.  There are siblings workshops which are run to assist the other children with the family find out more about SCI.
Chaplaincy services are also available, based on spiritual needs.
Peer support is available through partner charities which offer support and encouragement as well as practical suggestions regarding moving on with life.
Cultural Diversity:
Individuals of all cultures are admitted and the programme strives to meet
individual cultural needs of all patients. An example of how we strive to meet cultural diversity is through our chaplaincy and multi faith room that has been established to be useable for various religious and cultural purposes.

Nondiscrimination Policy:

The NSIC Rehabilitation programmes do not discriminate in their activities or programmes, or in admission, access to treatment on the basis of race, colour, gender, national origin, disability or age. Our goal is to embrace the diversity and unique experiences of our community.

Education and Training:

A comprehensive, individualised patient and family education programme is initiated upon admission and modified as the individual progresses in his/her rehabilitation programme. An established goal planning process takes place throughout a patient’s stay and the patient can invite his or her relatives or friends.
All members of the patient’s rehabilitation team provide education in prevention of additional problems related to risks of complications which can occur as a result of living with a spinal cord dysfunction. An individualised education manual is provided to the patient and family.
The Education programme covers all areas following spinal cord dysfunction and includes elements related to primary prevention of additional trauma or injury to the spinal cord.
Training and education will also help to overcome barriers that limit one’s ability to participate in social, leisure and vocational aspects of life activities, including safety in these environments.
Content can also be related to previous health complications that may further complicate spinal cord dysfunction and training for people who will be providing care when individual returns the community or moves on to a different level of care in the rehabilitation continuum can be provided.
There is a comprehensive day for relatives to learn more about SCI and meet people in similar situations to their own.

There are numerous opportunities for staff training at all levels of experience from core needs to a Masters Programme in advanced management of SCI.

Research activity:

There is strong research activity within the NSIC and associated links to other organisations. There are staff with professional academic and clinical roles. These posts facilitate trainees and doctorial research students to the centre. There are also national and international links and the NSIC is a core member of the UK Spinal Cord Injury Research network (UKSCIRN)  and there are a number of university collaborative agreements. The Stoke Mandeville Spinal Foundation (SMSF) is also in the early days of development but which will be a key research arm in the future.

Lifelong Care:

Based on individual needs, the Spinal cord injury consultant and the interdisciplinary team works with the patient over the course of his/her life in meeting the challenges of living with impairments and activity limitations. This team  will assist individuals served with life long health issues and prevention of potentials risks and complications.

System Relationships:

The NSIC Spinal Cord System of Care has established relationships with other providers in the broader rehabilitation continuum to help meet the
unique and changing needs of individuals in the programme. These relationships are varied, diverse, and changing.

Team members serve as resource to other providers for education and training to ensure personnel competency in addressing the needs of the individual along the continuum of care.