Delivering a National Service – Impact on patients and families Pam Green Senior Social worker Scottish Neurobehavioural Rehabilitation Service Neliss Baxter Outreach Nurse Scottish Brain Injury Rehabilitation Service

ABI NMCN Standard 3d Effective discharge is facilitated by a comprehensive MDT approach.

Rationale Discharge is a process-not isolated event Discharge is a process-not isolated event Started at earliest opportunity Started at earliest opportunity Comprehensive assessment of current and future needs. Comprehensive assessment of current and future needs. Engagement of individual, family and carers. Engagement of individual, family and carers.

CBP and RFU To provide a national brain injury and neurobehavioural service. To provide a national brain injury and neurobehavioural service. Assessment and rehabilitation for patients with complex care needs. Assessment and rehabilitation for patients with complex care needs. MDT – PT, OT, SALT, Neuropsych & SW. MDT – PT, OT, SALT, Neuropsych & SW. CBP – 20 beds. CBP – 20 beds. RFU – 19 beds within a locked unit. RFU – 19 beds within a locked unit. Based in Morningside, Edinburgh Based in Morningside, Edinburgh

Case Study - Brian 18 – parents & 2 siblings 20 & – parents & 2 siblings 20 & 7. 3 bedroom flat in rural location. 3 bedroom flat in rural location. Employed full time as a builder. Employed full time as a builder. Enjoyed going out with friends, computers and motorbikes. Enjoyed going out with friends, computers and motorbikes.

Rear seat passenger – RTA Rear seat passenger – RTA GCS 3 at the scene GCS 3 at the scene Diffuse axonal injury & frontal contusions Diffuse axonal injury & frontal contusions Multiple orthopaedic injuries Multiple orthopaedic injuries Required ventilation & induced coma Required ventilation & induced coma

Admission Increased tone left UL and LL Increased tone left UL and LL Ataxic Ataxic Reduced coordination Reduced coordination Self propel wheel chair very short distances – fatigues easily Self propel wheel chair very short distances – fatigues easily Assistance with personal activities of daily living Assistance with personal activities of daily living

Cognitive & Communication Issues Poor insight Poor insight Reduced memory Reduced memory Poor concentration Poor concentration Distractibility Distractibility Poor planning & organising Poor planning & organising Dysarthria Dysarthria

Behaviour Irritable Irritable Frustration and anger Frustration and anger Physical & verbal aggression- family & staff Physical & verbal aggression- family & staff Impulsive Impulsive Disinhibited – sexual Disinhibited – sexual Poor self monitoring Poor self monitoring

Impact on the Patient Isolated from friends & Family Isolated from friends & Family Boredom Boredom Lonely Lonely Frightened Frightened Grief/loss Grief/loss

Impact on Family Unfamiliar area/staff Unfamiliar area/staff Stigma Stigma Grief/loss/anxiety Grief/loss/anxiety Emotional exhaustion Emotional exhaustion Distance & travelling Distance & travelling Hospital accommodation Hospital accommodation Finances Finances

Support Keep families in the loop Keep families in the loop Positive relationships with patients Positive relationships with patients & families Involve patient & relatives in Involve patient & relatives in rehabilitation process Provide information Provide information Communication opportunities Communication opportunities Financial help Financial help

Discharge Planning – Brian Challenges Local care community assessment Local care community assessment Unsuitable housing Unsuitable housing Will require personal care – 24/7 Will require personal care – 24/7 Accessing Home - limited Accessing Home - limited Families expectations - high Families expectations - high Financial & Legal advice Financial & Legal advice

Geography & Distance Out of sight out of mind Out of sight out of mind Communication Communication Assessment challenges – 2 way Assessment challenges – 2 way Identifying resources for support plan Identifying resources for support plan

Home - Brian Limited opportunities Limited opportunities Lack of resources Lack of resources Dependency on family/support Dependency on family/support Loss of control Loss of control

Home - Family Carer burden Carer burden Strain on relationships Strain on relationships New house – difficulties New house – difficulties Support from outreach team during transition Support from outreach team during transition Adjustment & acceptance Adjustment & acceptance

Support package post discharge Making it work Making it work Confidence Confidence Information Information Mentoring Mentoring Understanding Understanding

ABI NMCN Standard 3d Effective discharge is facilitated by a comprehensive MDT approach.