By Liam Rice, MS Nurse Specialist, Royal Hallamshire Hospital

MS Intermediate MasterClass 8, 2019
This project was awarded runner up in the MS Academy MasterClass Project Award

Sarah Gillett, Liam Rice and Dr David Paling

Poster

Rice-poster-project-MS8.2-Dec-2019

Introduction

The Multiple Sclerosis (MS) / Urology servicewas set by up Liam Rice, MS Nurse Specialist and Consultant Urological Surgeon Miss Reid in 2014. This innovative service was established to provide a robust, pathway driven service to help MS patient’s better cope with debilitating bladder and bowel problems.

Individual pathways were developed for each problem which could be used by all of the MS Nurses within the MS service.

Background

My inspiration came from recognising the need for such a service working across specialities with Miss Reid who, herself has a special interest in bladder problems within the MS patient caseload Miss Reid recognised that patients attending her appointments had symptoms that could be managed in a different way. I have a background and interest in Urology and wanted to use this within my role as an MS Nurse Specialist.

We joined forces to look at ways of improving the care and outcomes through a structured, pathway approach. We looked at some of the established routes of care from both Urological and Neurological perspectives before setting up this service.

Before we set up this service patients were reviewed by MS Nurses, and if needed were referred to local continence and Urology department if further intervention was needed. The input they received however was not specific to the MS Neurogenic bladder and bowel which resulted in patients not receiving a thorough assessment with a seamless pathway. This way of working also put pressure on other services.

Successes

  • We have established five key transferable pathways that have been implemented very successfully. These are making a huge difference to our patients as patients are referred straight to our service, reducing the pressure on community teams and saving money.
  • As an MS team we use these pathways beyond the Urology/MS clinics.
  • Due to Miss Reid’s involvement we have taken a lot of the techniques from the spinal injuries unit.
  • Patients with MS can have catastrophic exacerbation of symptoms due to infection which we now manage through the MDT. We have seen a reduction in admissions for urinary tract infection (UTI) due to robust UTI management and providing patients with robust information sheets regarding UTI management.
  • We have received positive feedback from patients who are grateful to have a bespoke service.

A recent service evaluation which was carried out between July –September 2019 with a sample group of 35 was overwhelmingly positive about our service and most patients said it had improved their continence issues.

Conclusion

Through setting up this service we have provided:

  • Structured pathways to manage neurogenic bladder issues
  • Robust referral criteria used throughout both Urology/Neurology to manage MS/Uro patients
  • Patients seen regularly in Nurse led MS/Uro clinic
  • On-going development of pathways
  • Dissemination throughout both the urology and neurology directorates,

Future of the Service

  • To provide a continuing, evolving service that keeps updating, reviewing and improving the individual pathways.
  • To look at developing new pathways including SPC post-op care, conveen management.
  • To continue disseminating the service to a wider group including GP and continence teams