North Middlesex

University Hospital
George Marsh Centre
 Home Care Scheme For Patients
With Sickle Cell Disease
 Started in 1998, due to “winter pressures” funding

 The service is so far Unique in the National Health

Service

 Founder: - Dr Anne Yardumian

Consultant Haematologist,
NMUH
- Penny Butler
Enfield & Haringey HA
 RED CELL TEAM
ADULT
 Consultant Haematologists Paeds Haem
Paediatricians
 Specialist Nurses

 Counsellors 5 WTE

 Day Unit nursing team

 Social Worker

 Housing Officer

 Benefit Officer
 THE SCHEME OPERATES WITHIN A NETWORK
HOME
CARE
SERVICES
District Nurses

Social Services
Outpatient
Benefits
Services
Housing

Patients with Occupational

In-patient Services
SCD Therapist

General
Haematology
Practitioners
Department
Pharmacy
 RATIONALE
 Frequent hospital admissions, a model of care not
appropriate for management of Sickle Cell Pain
(Maxwell et al, 1999)

 Patients frequently spent >2 weeks in hospital

(Yardumian, 1993)

 High incidence of SCD in Community served by

NMUH

 Shift to different model of care in the best interest of

patients with SCD

 Flexibility
 HOW THE SYSTEM WORKS
* Initial assessment by Consultant
Hereafter - Referrals from Haematology
team
- Self referral
• Home Visits

• Frequency / duration of Home Visits

When last used service?
• Priority of Visits
How recently in hospital?
 HOME CARE FLOW CHART
Initial Assessment / Referral from Pts
New Referral by already on
Consultant HC Scheme

Admission Pack Check Record for:-

Drugs - Date of Discharge from Hospital
Protocols - Date last seen by HC team

Arrange Home Visits

-Contact pts by phone
-Confirm date visits will be made
(pts will be seen according to priority)
- Inform pts about possible delays

During Visit If in Doubt

If within normal limits
- Hx - Contact Haem Team for advice
Treat & advise
-CVS Observation - Refer pt for further assessment
accordingly
- Admission if necessary
- Documentations / GP Letter
- Record on Pas
- Referrals as necessary to SW, Housing / benefit ofiicer
 Frequency And Duration of
Home Visits
** Home Visits can take place:
* For up to 5 Working days
* Twice a day ( Ideally once a day last 2 days)

** Following discharge from hospital

* Up to maximum of 3 days

** Further visits within 2 weeks (14 days)

** Intermittently 2 days per week up to 4 weeks

 WHAT HAPPENS DURING HV?
CLINICAL ASSESSMENT
 History

 Assess – general

 Locality / Severity of pain (Pain score)

 Medications

 BP / Pulse / Temp / O2 sats

 Blood Specimen

 Treatment

 Advice
 Circumstances Where Hospital
admission is Advisable
 Chest pain

 Moderate or high fever (at or above 38 degrees C)

 Any shortness of breath or difficulty breathing

 Abdominal pain

 Diarrhoea + Vomiting

 Severe headache, black out, Muscle weakness in one arm or

leg

 Any symptoms not recognise or which are just different from

usual bone and joint pains
PRIORITY OF PATIENTS FOR
HOME CARE
• Users who have had no contact with either the home care
service or admission to hospital for 4 weeks or more

• Users who have not used the home care service for more
than 2 weeks and have not been admitted to hospital for
more than 4 weeks

• Users who have had no contact with either the home care
service or admission to hospital for 2 weeks or more

• Users for first three days of home care treatment who have
been discharged from hospital

• Users who did not receive the maximum number of visits

during their last course of home care.
 BENEFITS TO PATIENTS
 Easy access to treatment

 Seen by specialists nurses everytime

 Early discharge from hospital

 Reduce risk of HAI (i.e MRSA etc..)

 Positive outlook to life / Opportunities :-

- Studies / Training
- Part - time jobs
- Enjoyment of normal
family & social life
 BENEFIT TO THE TRUST
 Better use of resources

 Reduce waiting time in A&E dept

 Reduce number of bed days

 Trust able to treat other acutely ill pts, thus

overall increase the number of pts treated
in the hospital

 Staff become increasingly

experienced / expert
Admissions, and in patient days, per year:
by individual patient, years pre- and post-
service
8
7
6
5
av CCE
4
av total LOS
3
2
1
0
yr-3 yr-1 yr+1 yr+3 Yr+5
SO … WHAT DID WE ACHIEVE?
 Number of admission by SCD pts significantly
reduced

 Improve relationship between staff and service

users

 Achievement of active users’ involvement and

partnership (New NHS 1999)

 Flexibility

 Major improvement in pts’ QOL

 IN THE USER’S WORDS
 …‘it helps me to relax and in between visits I can
distract myself better at home, taking my mind off the
pain’

 ‘It makes my recovery a lot smoother … I am the

mother of two small children and the thought of being
separated form them used to affect my health’

 ‘I find I do not need as many injections as I would in

hospital’

 ‘It has reduced the number of days off work’

 ‘…it is a lifeline’
WHERE DO WE GO FROM HERE
 Increase service provision

 Late evening service

 Expand catchment's area

 Specialist nurses 7 WTE

 THANK YOU
Nasser Roheemun
Specialist Nurse
North Middlesex University Hospital
nasser.roheemun@haringey.nhs.co.uk