1. North Middlesex University Hospital
George Marsh Centre

2. 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

4. RED CELL TEAM Consultant Haematologists Paeds Haem Paediatricians
ADULT
Consultant Haematologists Paeds Haem
Paediatricians
Specialist Nurses
Counsellors WTE
Day Unit nursing team
Social Worker
Housing Officer
Benefit Officer

5. THE SCHEME OPERATES WITHIN A NETWORK
HOME
CARE
SERVICES

6. 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

7. 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?

8. HOME CARE FLOW CHART Initial Assessment / Referral from Pts
New Referral by
Consultant
Referral from Pts
already on
HC Scheme
Admission Pack
Drugs
Protocols
Check Record for:-
Date of Discharge from Hospital
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
If within normal limits
Treat & advise
accordingly
During Visit Hx
CVS Observation
If in Doubt
Contact Haem Team for advice
- Refer pt for further assessment
Admission if necessary
- Documentations / GP Letter
- Record on Pas
- Referrals as necessary to SW, Housing / benefit ofiicer

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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

16. 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
Scheme welcome by pts / relatives

17. 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’

18. WHERE DO WE GO FROM HERE Increase service provision
Late evening service
Expand catchment's area
Specialist nurses 7 WTE

19. THANK YOU Nasser Roheemun Specialist Nurse
North Middlesex University Hospital