The MDT (2) PDF

The multidisciplinary team Learning Objectives By the end of this session you should be able to; Understand the stages of a doctor's career in Ireland Discuss different people working in a hospital and their role in patient care Understand the roles of different team members in healthcare...

The multidisciplinary team Learning Objectives By the end of this session you should be able to; Understand the stages of a doctor's career in Ireland Discuss different people working in a hospital and their role in patient care Understand the roles of different team members in healthcare Appreciate the importance of each team member in providing patient centred holistic care Understand a worked example of MDT input/management pathway Hospitals 101 Who is who The medical team Consultant 1 SpR +/- 1 Reg 1-2 SHO 1-2 interns +/- Research fellow +/- clinical tutor/lecturer 1-5 medical students (Yr3-5) The medical team reporting structure and career progression CONSULTAN T Specialist Registrar & Registrars 4-6 years SHO – Senior House Officers minimum of 2 years Interns 1 year Medical Students/Student Doctors 4-6 years What is an MDT? A multi-disciplinary team; A group of professional healthcare workers who are members of different disciplines who each have unique skills to support the patient. The team activities are co-ordinated via a care plan which allows the team to review/understand the overall goals set for that specific patient. The group may complete their tasks individually but they remain mindful of the overall care plan. Often one person is the main co-ordinator/key point of contact for the person; Key worker. Nice video explanation: https://youtu.be/bENp2Imh0Rw Nursing in Ireland Director of Nursing Assistant director of nursing (ADON) Advanced Clinical Nurse Nurse Practitione Specialists( rs (ANPs) CNSs) CNM (1,2,3) Clinical Nurse Managers CNM1; Assistant ward manager CNM 2; Ward manager CNM3; Department manager Staff Nurses Nursing Interns & Student nurses Mr Burns, 72 year old man who presented to ED this am Presented to ED having awoken with slurred incomprehensible speech, weakness down his (R) side and a (R) sided facial droop. He had gone to sleep approx. 8 hrs earlier & was well. What do you think might be going on? He underwent CT angiogram – demonstrated a clot in middle cerebral artery What next…. Is Mr Burns a candidate for thrombolysis?  Alex, 72 year old man who presented to ED 2 weeks ago. He was transferred to Beaumont hospital (Dublin) & underwent thrombectomy He was transferred back to GUH today for ongoing post stroke care. Useful video here: https://www.youtube.com/watch?v= Cr9Pb3liSlA Common teams that work in MDT’s Stroke care Cancer care Care of the elderly Cystic Fibrosis Cerebral Palsy Complex care needs Diabetes Transplant care Psychiatric care teams  Mr Burns, 72 year old man who presented to ED 2 weeks ago. He was transferred to Beaumont hospital (Dublin) & underwent thrombectomy He was transferred back to GUH today for ongoing post stroke care. Useful video here: https://www.youtube.com/watch?v= Cr9Pb3liSlA Hello My name is...... Health and Social Care Professionals HSCP 26 professions 25% of clinical workforce What do physiotherapists do? “Healthcare professionals who are responsible for developing, maintaining or restoring movement and functional ability throughout the lifespan across the health spectrum using evidence based practice” Irish society of chartered physiotherapists They - Relieve pain & treat/prevent physical conditions - Promote physical independence & empower patients to manage their condition outside the clinical setting - Design & prescribe interventions specific to the individual to help people where movement/function is threatened by illness/pain/ageing/injury/disability/disease Functional movement is central to what it means to be ‘healthy’ Regulator - CORU What can physiotherapists do in a hospital setting? Specialist areas of knowledge e.g. musculoskeletal, cardiac, neuro, ICU, resp (similar to specialities within medicine) Encourage (and assist if needed) patients to mobilise post operatively or if admitted for a medical reason (where appropriate) Provide equipment to help patients prevent further complications e.g. pneumonia/chest infections Adapt a persons physiotherapy regime to keep the person engaged e.g paeds physio – blowing bubbles, playing football Perform physical therapy to relieve pain or encourage expulsion of sputum (esp if patient in ICU). Review patients both on the wards & who attend from home for ongoing input. What do occupational therapists do? ‘Occupational therapy is a healthcare profession offering support to people with physical, psychosocial and social problems to enable them to live life to the fullest. They help people to do the everyday activities they want and need to do when faced with illness, injury, disability or challenging life circumstance/events.’ Association of Occupational Therapists of Ireland The term occupation is used to describe all the things we do to take care of ourselves & others (socialise, have fun, work, learn, contribute to community & society). Essentially anything that fills our life & gives it purpose & meaning They support people to reach their maximum level of autonomy & independence (For children, they also help them reach their maximum level of skill attainment) They take a strength focused approach What can occupational therapists do in a hospital setting? Perform functional assessments with the person to assess what they find challenging; May organise a home visit so they can view some tasks as they are performed in the home (in case the home requires adaptation also) Can provide assistant equipment e.g. grab rails/shower chairs/wrist splints Can measure & advise about specialist equipment e.g. supportive wheelchairs Formal verified occupational assessments re: cognition/development/function Regulator : CORU What do speech & language therapists do? A speech & language therapist is a qualified individual who works with clients that present with communication difficulties such as - Childhood speech & language disorders - Stammers - Eating, drinking & swallowing difficulties - Acquired speech & language disorders e.g. post acquired brain injury (ABI) - The Irish Association of Speech & Language therapists (IASLT) What can speech & language therapists do in a hospital setting? Assess a persons ability to safely swallow & chew Suggest further investigations/interventions if needed in assessment process e.g. video fluoroscopy, barium swallow. If a person has some limitation in their ability; advise what type of food/liquid is safe/appropriate for them e.g. soft diet, thickened fluids, NPO Assess & provide therapy to patients with communication difficulties e.g. post stroke care, post laryngectomy care etc. What do dieticians do? A dietician is a healthcare professional who specialises in food and nutrition in either a hospital or a community setting. Dieticians apply the science of nutrition to promote health, treat and prevent malnutrition and provide therapeutic dietary guidelines for patients, client and the public in health and illness - Irish Nutrition & Dietetic Institute (INDI) Treat patients using their knowledge of the medical condition involved & the application of nutrition in the prevention, treatment & management of the condition. Only nutrition profession eligible to be employed by the HSE. Advise on nutritional needs and if appropriate nutritional supplementation Regulator: CORU Nutritionist and public health nutritionists – are eligible for registration with a UK group and can work in public health. They are not eligible for registration with CORU. May work in public health etc. Usually BSC or MsC in nutrition. Note nutritional therapists – are not a regulated group What can dieticians do in the hospital setting? Identify malnutrition and act on it Work within an MDT to treat complex clinical conditions e.g. liver disease, kidney disease, cancer, diabetes, allergy etc. Work out caloric requirements and suggest ways to meet these requirements that are in keeping with the patients underlying condition & treatment plan Educate other healthcare professionals about nutritional supplements & other feeding pathways e.g. total parenteral nutrition (TPN) Advise on appropriate nutrition interventions based upon evidence and careful medical, dietary and lifestyle histories. Educate patients & their families about their diet & nutrition needs prior to discharge & liaise with community dieticians (if needed/appropriate) What do social workers do? Social work is a profession promotes social justice. It aims to empower individuals, groups and communities to take charge of their own lives within their own environment & social context. -Irish Association of Social Workers Social workers promote equality; they highlight & address issues relating to discrimination & inequality in society. Social workers take a holistic view of people and their difficulties. Interventions they can suggest; individual counselling, family work, group work, crisis intervention, assessment, access/info about benefits/entitlements What can social workers do in a hospital setting? Depends on their specific role Can provide psychological support to patients/families Can provide practical support e.g. suggest entitlements/benefits, create supportive letters for social housing needs, link to charities etc. Attend MDT meetings to be an additional voice for the patient Liaise with social work teams in the community; continuity of care Busy & varied role.  A CNS is a clinical nurse specialist. An ANP is an advanced nurse practitioner. They have a particular interest in a certain area of nursing and strive to be a clinical expert within that specific area/in relation to a specific condition What do Focuses on a major clinical focus of care to patients or clients and their families in hospital/community/OPD CNS’s/ANP setting. ’s do? They have undertaken further formal study in their area of interest (masters level if ANP, higher diploma or higher if CNS). ANP; autonomous expert clinical practice, professional & clinical leadership & research CNS; specialist clinical practice, patient advocacy, consultation, education, research & audit.  What can CNS’s/ANP’s do in the hospital setting? CNS ANP Educate patients about their Run their own clinics & area of speciality including review patients useful tips/tricks for managing Prescribe certain new equipment medications/instigate Review patients & flag certain concerns to treating team if therapies/management needed plans in their area of Provide advice/troubleshooting expertise. support to general nurses on Can refer patients for the ward additional review/services. What do psychologists do? Psychologists seek to help people with a range of personal challenges. Frequently these problems cause distress and effect how someone is feeling/thinking/behaving or learning. Psychologists are trained to apply their knowledge in practical ways & explore ways to make change. Some common types of psychologist include; Clinical psychologist; trained to offer a range of services including specialist assessments/interventions. Counselling psychologist; therapeutic interventions Educational psychologist; support learners in schools & in disability service settings What can psychologists do in the hospital setting? Review patients & offer support during acute times of crisis Assess & offer interventions to support psychological well being Provide insight during MDT meetings to help plan for the ongoing care of the patient Help the patient develop coping skills to manage their condition/overcome their phobias Allow a patient a safe space to process a new diagnosis/new stage of their condition Who are pharmacists & what can they do in the hospital setting? Pharmacists are integral to ensuring the safe prescribing & dispensing of medicines both in the community & in the hospital setting. - The pharmacy regulator (PSI) (Pharmaceutical society of Ireland) Regularly review drug kardexes & discuss with medical teams potential drug interactions/encourage discontinuation of any medications no longer required/ flag potential medication interactions Can discuss a patients discharge prescription with them prior to discharge (especially if there are multiple medication changes) Dispense medications in the hospital pharmacy/make up medications as required for the ward/day admissions/haemonc unit. Let’s talk about Mr Burns  Alex, 72 year old man who presented to ED this am Presented to ED having awoken with slurred incomprehensible speech, weakness down his (R) side and a (R) sided facial droop. He had gone to sleep approx. 8 hrs earlier & was well. What do you think might be going on? He underwent CT angiogram – demonstrated a clot in middle cerebral artery Is Alex a candidate for thrombolysis?  Acute stroke unit MDT Nurses Doctors SALT Physiotherapy Dietician Occupational Therapy Social Worker Neuropsychologist Pharmacist Ongoing care needs Home vs. Rehab unit Merlin park National Rehab Unit (Dun Laoghaire) GP review May have ongoing therapy needs; ?link to community vs. attend hospital for follow up May need adaptations in the home if mobility has changed since admission Require/benefit from home help?