1. THE ROLE OF THE KEYWORKER WORKING WITH STROKE PATIENTS
LINDA LAWDEN
BRYNHEULOG WARD NEWTOWN
Hello everyone, my name is Linda Lawden and I work on Brynheulog ward at Newtown hospital where I have been the ward sister for over 2 years
As part of the CLP course we have been given the opportunity to carry out a project relevant to our work place which will in turn enhance patient care. My project is- THE ROLE OF THE KEYWORKER WORKING WITH STROKE PATIENTS

2. INTRODUCTION 5 STROKE CARE BEDS REHABILITATION
ALL WALES STROKE PATHWAY
THE INTRODUCTION OF THE KEYWORKER
This year at Newtown, we have been fortunate enough to open 5 new beds which have been identified for stroke rehabilitation and have a new therapies unit offering excellent rehabilitation to our stroke patients and in fact to all our patients providing they have rehabilitation potential.
We are working with the All Wales Stroke Pathway which indicates that all stroke patients are given a key worker on admission or as soon as possible. The aim of my project is to introduce this new role to the trained nurses on Brynheulog ward

3. DEFINITION OF A KEYWORKER
THE KEY WORKER IS A
“person who, with the patients’ consent and agreement, takes a key role in co-ordinating the patients care and promotes continuity, ensuring the patient knows who to access for information and advice”
(NICE, 2004)
According to NICE guidelines,(2004) a key worker is a person who, with the patients consent and agreement, takes a key role in co-ordinating the patients care and promotes continuity, ensuring the patient knows who to access for advice.

4. WHAT IS A KEY WORKER WHAT IS A KEYWORKER
Support and plan discharge
advocate
Answer questions
Attend goal planning meetings
Assist with patient journals
Keep patient up to date with progress
Provide support
WHAT IS A KEYWORKER
The key worker must act as an advocate, as well as ensuring the patient knows who is the main point of contact
To answer any questions and to communicate and coordinate information for the patient and their families
To attend weekly goal planning meetings, firstly recognising goals and discussing these with the team to ensure continuity among the different disciplines
To provide each patient with their individualised patient journal and explain its content
To keep the patient up to date with their progress and discuss weekly goals
To provide support throughout their hospital stay
And most importantly to plan a safe , successful discharge

5. WHO IS THE KEYWORKER
The key worker can be any qualified member of the MDT
It is likely that the key worker will be a nurse, unless other problems are identified
Will be allocated based on referral information and off duty on day of transfer
Will be supported by a lead therapist
WHO IS THE KEYWORKER
The key worker can be any qualified member of the Multi disciplinary team, which is likely to be a nurse, unless the patient has specific communication, cognitive or physical problems, in which case it may be more appropriate for the key worker to be a therapist with expert knowledge in that particular area
Will be allocated on day of transfer, or as soon as possible after
And will be supported by a lead therapist

6. HOW TO TAKE THIS FORWARD
Met to discuss my project with Michelle Price(Consultant Therapist)
Discussed Teaching other Staff Nurses
Devised a teaching pack
Weekly goal planning meetings
Arranged a visit to the Stroke ward at Shrewsbury
HOW TO TAKE THIS FORWARD
We have a Consultant therapist, Michelle Price based at Newtown, I was able to discuss the aim of my project with her. Michelle is employed to over see stroke/Neuro rehab in Powys so I was able to gain a lot from her knowledge and expertise
Initially I was the key worker for all the newly transferred stroke patients, but this proved too much for one person
Michelle helped me to deliver short teaching sessions to some of the staff
I then had to put the information together in the form of a teaching pack for all staff to read, especially those who could not attend the study session
We also have weekly goal planning meetings held on a Wednesday, ideally the key worker should attend to discuss progress and set new achievable goals that are individualised for each patient, these goals are then fed back to the patient and placed in their journal which is kept at the bedside
Many of the staff from Newtown have been fortunate enough to do some work shadowing on ward 22S at Shrewsbury and were able to see how they allocate key workers and if we could learn any thing from them, it was found that their key workers are the admitting nurse who is on duty on their arrival to the ward.

7. SOME OF THE PROBLEMS faced
Part time staff
Staff absences
Poor continuity
SBAR
Many of the problems were that nursing staff are part time, on annual leave or sick, this meant a poor continuity and a different nurse attending the goal planning meetings each week, some of which may have been on leave and not knowing the patient so well
This key worker role is still work in progress, so as a sort of recap, I have put all the problems in the form of an SBAR which is Situation, Background, Assessment and Recommendations

8. SITUATION Need a reliable person No clear roles and responsibilities
Need to involve patients and their families
Need to improve discharge information
The team have been struggling to establish a reliable process for implementing stroke care bundles on the ward, there are no clear roles and responsibilities around filling in the patient journals, involving patients and their families in a meaningful way on goal planning and filling in transfer of care documentation and giving out accurate discharge information

9. BACKGROUND
Clinical team at Newtown have been working towards the stroke care bundles for 2 years
Initially Sister was key worker to all stroke patients
Project looked at involving other trained nurses taking on the key worker role
Clinical team at Newtown have been working towards implementing the stroke care bundles for2 years, initially Sister was the key worker for all the stroke patients.
Part of my project was to delegate this role
Nursing teams split so that one would look after all the stroke patients to make MDT easier
Therapy planning or goal planning meetings have evolved which have improved the whole teams understanding of the importance of working together to provide achievable patient goals
Discharge papers are now started in the weekly meetings so that no information is missed

10. ASSESSMENT No clear goals Key worker role is pivotal
Nurses work shifts
Introduction of therapists as key workers
There is no clear accountability of who should be doing what in regard to discussing goal planning and filling in documentation
Nurses aren’t’ always clear on what goals are achievable to each patient
The key worker is pivotal in achieving this
The difficulties were with the nurses as they work shifts and different nurses were attending the therapy planning meetings so it was decided that :
There would be more continuity if the therapists were the key workers as they can always attend the goal planning meetings and the MDT
They would need to work closely with the nurses as they spend the most time with the patients and have better links with relatives and carers

11. RECOMMENDATIONS Each patient is now given a therapist as key worker
Each patient should have a specified stroke support nurse
The patient experience is vital in rehabilitation
Learning curve for all staff at Newtown
Each patient is now given a therapist as a key worker
Each patient has a specified stroke support nurse
These 2 professionals should liaise closely with each other and the patient to ensure our patients are given the best possible rehabilitation programme to ensure a safe discharge
My project firstly looked into delegating the role of key worker to the trained nurses on the ward which they still do, but more as a supporting role, but nevertheless I feel they have all had the opportunity to act as key worker and many have been able to contribute to the weekly goal planning meetings and weekly MDT meetings in a far more positive manner.

12. THE END I would like to thank you all for listening Linda Lawden
Brynheulog ward Newtown
Tel