Managing demand for specialist services

The Map is helping the Gwent healthcare community reduce the numbers of catheterised patients needing hospital treatment. Nurses are responding positively to having easy access to evidence-based best practice and it is helping to ensure more patients are being treated in the community. Gwent’s pathway was highly localised, a process that took just two months.

Gwent’s Continence Service Head Karen Logan and project leader Joanna Dundon describe the Map's role in improving catheterised patient management (4:56)

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Transcription

Karen Logan: In Gwent we can estimate that about 22,000 people suffer with urinary incontinence and an extra 6,000 with faecal incontinence and there are many more, possibly up to 50,000 with symptoms of frequency and urgency. So it’s a big area, a very common problem incontinence, particularly in men and we need to treat patients in a preventative way so that they can perhaps best manage their problem themselves rather than coming into hospital and into secondary care. There is a lot of health promotional work that they could be doing and that’s where my team come in in terms of training them to conservatively manage their bladder and bowel problems.

Interviewer: What potential problems with the system then Karen do you foresee the Map helping you with?

Karen Logan: With the particular area, this particular project of the management of the catheterised patient it’s really going to make evidence based practice available to nurses so that they can follow if you like a pathway that allows them to put in place measures at the right time in the right place that manage patients with catheterised problems or catheter related emergency problems, particularly in the community setting rather than bringing them into hospital.

Interviewer: So is it something that the nurses are responding positively to?

Karen Logan: Yes they are very excited about this project, it’s been something we’ve been working on for a number of years but now that we finally have the pathway in place, they’ve got something that they can easily access to follow to enable them to do the right thing.

Interviewer: Joanna have there been any advantages to being an early adopter of this system?

Joanna Dundon: I think so, it means that we can actually go out and spread the word across Gwent that there is a new tool available for them to use and actually getting them then to champion the Map across other areas of Wales and the UK.

Interviewer: So how will the use of the Map be expanded now?

Joanna Dundon: Well hopefully with one of the projects in Gwent where the GP Out of Hours, we are linking in with their Electronic Health Record system and we’ve also piloted the PDA version, the Mobile Map which has been very positive especially with the Welsh Ambulance Service and we would like to see that continue as well.

Interviewer: Karen it’s very much been localised hasn’t it, could you explain to us how that has worked?

Karen Logan: Yes, I met up with Joanna just about the time that I was writing the catheter policy and we discussed the potential for using the Map of Medicine to enable it to be more widely accessed, particularly across Gwent and for GPs and Joanna thought it was going to be an excellent example of a localisation project and within quite a short space of time actually, within two months from meeting up and deciding that we were going to do this, we’ve actually published the localised management of the catheterised patient.

Interviewer: Joanna do you have any tips for people who are going to adopt the Map to make the process more smooth for them?

Joanna Dundon: I think first of all get senior buy in from clinicians and managers, that’s made it much more easy for me to sell the map and also just communicate as widely as you can about what’s going on. We have an intranet website as well as the information that comes from the Map; we email all our users as well to make sure that they know what’s coming up and what’s been localised as well.

Interviewer: So Karen what measures have been put in place in order to gather evidence about how effective the map is being for you?

Karen Logan: I put a robust action plan in place so that we can monitor whether the Map of Medicine pathway is being used and we are actually changing practice and making a difference. One of the first things that we are going to be doing is my team runs a training course, a catheter training course and we will be monitoring whether delegates are accessing the map and using it during those training courses and using a similar approach at senior nurse meetings. The second way that we plan to do it is via an audit of clinical practice within the urology department to monitor and quantify the number of patients that are coming through inappropriately to secondary care for management of their catheters and we are hoping to see a downward trend.

Interviewer: So how long is it going to be before there is actually evidence of how effective this is being?

Karen Logan: I would say six months is where we will have some evidence from the clinical audit and possibly before then in October when we run our next course we will have about 40 delegates attending.

Interviewer: Soon.

Karen Logan: Soon.