MOTOR NEURONE DISEASE IN THE EMERGENCY DEPARTMENT HANNAH PRESTON, FY2 Royal Infirmary Edinburgh

BACKGROUND Motor Neurone Disease is a non-curative degenerative neurological disease Incidence in Scotland is 1-4/100,000 Men 3:2, Average age 60yrs, Fatal in 2-4 years. It requires an MDT approach Specialist nurses, consultants, OT, dieticians, GP, SALT Most care is carried out at home with specialist input Acute crises do occur and patients will present to acute services May be related to unrelated to their condition

Emergency Department considerations Many do not know about the complexity of the disease Presentations may or may not be related to MND Aspects to consider: Oxygen Locate next of kin Do they have a care plan? DNAR? Advanced statement? MND alert card? Do they have an enteral feeding tube? Consider appropriate drug administration route Do they use NIV? Do they have capacity? Contact MND specialist They may not be able to lie flat for Xrays Communication Carer breakdown

AIMS baseline Reduce emergency admissions of MND patient by 30% Reduce admissions of MND patients to general medical wards by 50% baseline Trak search from 2014-current Presentations, admissions, progress and treatment

findings 18 led to admissions at least overnight (45%) 66 MND patients in Lothian 40 ED RIE presentations (2 had 4, 1 had 3, 2 had 2) 18 led to admissions at least overnight (45%) MAU was the most common admission location 5 transferred to DCN at WGH (28% of >1day admissions) 1 rapid access clinic with neurology OP organised 2 sent to SJH Of all presentations MND/neurology were involved from TRAK documentation in 8 patients (20%) Occupational therapy were involved 2 cases prior to safe to go home from exam 3 for TTC follow up as outpatient with fractures 1 Head Injury and neurology observations

3 new presentations and diagnosis of MND (7.5%) No care plans on trak- used for complex patients 4 admissions clearly documented for not coping in current situation No protocol on EMIBANK or advice for MND patients for ED staff

REASONS FOR PRESENTATION

Future changes Teaching session to Emergency Department staff- delivered by Dr Davenport and Judith Newton To create care plans for all MND patients on TRAK Create a pathway on EMIBANK for staff to use and follow Phone numbers to call in and out of hours Liaison nurses for advice Home ventilation team numbers accessible Monitor admissions for evidence of improvement once implementations have been out in place

Thank you for listening… how do you feel we can improve?