Name: Martyn Wood
Job title: Paediatric Disability Clinical Specialist
Specialty: Children’s nursing
Organisation: University Hospitals Bristol NHS FT
I have set up a pre-admission screening system for children with disabilities to try to meet their needs coming in to hospital for elective admissions. This involves searching the electronic patient record for children with alerts for Learning Disability, Hearing Impairment, Visual Impairment & the Bristol Children's Hospital Passport and contacting the child's parent/carers approximately one week before admission to identify their specific needs based on the hospital environment, communication preferences, play and distraction, and the anaesthetic and recovery process.
This is backed up with video resources that can be accessed from home and offers of play support and desensitisation techniques (e.g. sending an anaesthetic mask home for children to play with, wash, decorate and then bring back in for use).
All patient information letters about admission to Bristol Royal Hospital for Children have the contact details of the Paediatric Disability Team on the reverse. Most phone calls that were made were 1-2 days before admission and in discussion with a range of parent/carers it was apparent that human factors meant that parent/carers typically read the front of the letter on receipt (the date and time of admission) and the reverse closer to the date...leaving little time to make changes.
The Equality Act (2010) states that service providers "take 'reasonable steps‘ and to make ‘simple modifications’ legally known as ‘reasonable adjustments’ to anticipate the needs of disabled people, not just to react as these arise.” It therefore seemed logical to make a proactive effort to contact families of children with identified disabilities in advance to anticipate needs with time to make reasonable adjustments.
Children where a disability has not been identified to the hospital and therefore no alert has been created can still access the Paediatric Disability Team the way they would but would be offered the use of an electronic alert for future admissions.
How did you initiate the work?
University Hospitals Bristol uses the Medway electronic medical record system and this has been utilised to add alerts to patient records for a number of clinical and social reasons, including learning, physical and sensory disabilities. Admission lists were already available and the Medway team created 10 day admissions lists for me for four wards with potentially complicated admissions. Information is shared with the ward, play and theatre teams in time to implement the requested reasonable adjustments.
What have the challenges to implementing the service/intervention been? And what has enabled the implementation of the service/intervention?
The main challenge to implementing this change has been time. the Paediatric Disability Team is 25 hours per week Band 7 (myself) and 15 hours per week Band 4 support worker. The number and complexity of patients identified can vary each week and only I am doing this work. This means that it has to sit alongside my other responsibilities and other parent/carers contacting directly.
Has the initiative or project made a difference to patients/service users and or staff?
There has been positive feedback from parent/carers, children and young people and from the whole multi-professional team saying that the pre-admission disability assessment makes the care of children with disabilities and complex needs easier with better patient and family experience. Reasonable adjustments have included the use of play for preparation and distraction, information sent out in a child-friendly format, allocation of side rooms, sourcing special beds and supporting parents and carers.
So far data has been collected for three consecutive quarters showing that a total of 181 patient attendances have been pre-assessed by the Paediatric Disability Team. The majority of these are attending the day case unit as this is the preferred location for children with disabilities to support a quick return to the home environment and avoid a complicated discharge following a longer stay. The largest specialty group is orthopedic surgery.
What are the long-term aims for the work?
At present the work is continuing as part of my role along side my existing responsibilities. There is work being developed to create more materials for children such as boxes to carry favourite items from the ward to recovery. Ultimately this work could be developed to either a stand-alone role or devolved to each ward area to take responsibilty for their own complex patients.