Spinal Case Studies – Study A
Client B is a 42 year old tetraplegic lady who at the age of 13 sustained C5/C6 injury. She has limited upper limb function and is a full time wheel chair user. She has a husband and an 18 year old daughter. The client’s husband is her main carer and he receives additional support from an agency each morning and two afternoons a week. The client’s parents live next door and also provide support if needed.
Client B contacted Active Assistance as her husband was planning to travel and visit his family for 5 weeks. She was very anxious as she has never been without her husband, nor had a stranger living in her home. The Care Service Manager (CSM) went out to meet Client B and her husband 3 months before the package was due to start. They both had lots of questions about what to expect and how the company works. Client B had never been treated at a specialist unit and was not aware of Autonomic Dysreflexia. The CSM explained to Client B what AD is and the symptoms of it, and Client B was surprised to realise she had been suffering with it occasionally for years. When the CSM left, both husband and wife felt more reassured. The CSM maintained contact during the two months before the package was due to start and visited the client again 3 weeks before to ensure all the information on the documents was correct. During this time the client was provided with information and a photograph of the PA who would be living with her.
The client was looking forward to the start date by the time the CSM left, knowing that everything was arranged. She said she felt reassured by the phone calls and visits she had received from the Care co-ordination team and the CSM.
The CSM prepared Client B’s documents and arranged for them to be sent out two weeks before the start date to allow the client time to look over them and tell the team if there was anything to be changed.
Within a few days of the care package starting B contacted the CSM to express delight with the way Active Assistance PAs were supporting her “… as good as my husband!”. The family has since requested that Active Assistance continue to provide ongoing support to the family.
Spinal Case Study B
AB is a 59 year old man with C4-5 Complete Spinal Cord Injury since 2001.
AB developed Pneumonia in 2007 and was subsequently given a Tracheostomy to aid removal of secretions and to manage and reduce incidence of further chest infections and Pneumonia. District Nurses were trained to undertake Tracheostomy changes and did this monthly.
AB suffers with Sleep Apnoea.
In 2009 following another bout of Pneumonia he required 24 hour ventilation for several months. He suffered a respiratory arrest during this time, probably due to a mucous plug and was successfully resuscitated immediately.
AB was weaned off the ventilator and was finally discharged with just overnight NIPPY Ventilation although he can manage without this if required. He uses a Cough Assist Machine at least twice daily after nebulizers and requires regular suction each day which can increase in frequency at times. It is known that his lung function will gradually deteriorate and that each bout of Pneumonia will weaken him further.
The PAs who first started the package following the last bout of Pneumonia worked with AB in the spinal unit for two days prior to discharge. They were taught all aspects of his respiratory care; suctioning, use of Cough Assist, Ventilation and Nebulisation. They learned when and how to use the O2 Saturations machine and how to change the tracheostomy tube in an emergency.
Following discharge, the NHS Respiratory Support Nurse visited the home and trained another PA and also several members of the district nursing team in changing the tracheostomy tube.
He now has 4 regular PAs who work with him and he is clinically stable, thanks to the competence and dedication of Active Assistance and NHS staff working together.
New PAs are currently trained in suctioning by the Care Service Manager (CSM). Competencies forms are completed to ensure all aspects such as infection control, technique and understanding are achieved.
PAs tend to work with the support of the regular PAs for a day or two before being signed off by the CSM. During this process they are also tested on use of the NIPPY Ventilator, Cough Assist, Suctioning machines, use of the Nebulizer and O2 Saturations machine. There are pictures of Tracheostomy changes held in the client file.
One PA has had some extended role training by the District Nurses jointly with the Care Service Manager who drew up the competencies (based on those produced by the RSN at Stoke Mandeville). She has now learned how to do routine changes of the Tracheostomy tube and does this monthly.
Spinal Case Study C
SP is a 65 year old lady who in 2008 sustained a C4/5 Complete Spinal Cord Injury as a result of a spinal bleed following surgery. SP’s prognosis is poor and she has been discharged to her home for palliative care.
SP lives at home with her husband. She has other family close by.
SP was never able to be weaned from the ventilator and as a result was given a Tracheostomy to aid removal of secretions and ventilation. There is minimal support from the District Nurses so all training for SP’s care needs were provided by Active Assistance. SP’s husband has been trained in all aspects of her care.
SP spent several months in the Spinal Unit in 2009 prior to her discharge home in October 2009.
SP is able to breathe for short periods of time without the ventilator but becomes very tired. Therefore, SP has been discharged home with a LTV ventilator. They require oxygen therapy, nebulizers and regular suction throughout the day.
Prior to discharge home a team of 4 PAs went to work with SP in the spinal unit for two weeks. They were taught all aspects of her respiratory care, suctioning, Ventilation and Nebulisation. They learned when and how to use the O2 Saturations machine and how to change the tracheostomy tube in an emergency.
On discharge home ongoing training and competencies were provided by registered Nurses provided by Active Assistance. Although much of the care required could be delivered by the Personal Care Assistants, SP’s condition is deteriorating and her husband is only able to relax when a trained nurse is on duty.
SP’s care is being supported by 2 live-in PAs working two weeks on and two weeks off (opposite each other). The live-in PA works during the day 8-10 hours and is available at night as she sleeps on site. The second person on duty is a registered nurse who works a 12 hour day shift. (Shift rota) Overnight there is a Personal Care Assistant working a 12 hour waking night.
SP’s husband has been trained as a back-up in suction, nebulizer and Tracheostomy care and changes. This was a requirement for the care package to ensure there was always someone trained in cases of sickness.