Wheelchair Service Redesign March 2009 by NpPzz8

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									Wheelchair Service Redesign
       March 2009
Context
 • Approximately 7400 wheelchair users
   – (92% Grampian, 4% Orkney, 4% Shetland)
 • Staffing –
    – 4 Occupational Therapists + 1 OTA
    – 2 Bioengineers
    – 8 Technical Staff
    – 2.5 Admin staff
 • Covering Aberdeen, Aberdeenshire,
   Moray, Orkney & Shetland
 • Area covered = 8700 sq km + Islands
 • Population 556,000
Redesign Event
 • 1 week – late March 2009
 • All of clinical team + Admin + Technical
   staff + input from Finance Manager
 • Internally organised – facilitated by NHSG
   Improvement & Development Manager for
   Service
 • Looked at Patient Journey – identifying key
   quality issues
 • “Moving Forward” & Action Plan
   implementation – Local Action Plan
 • Capacity of service
 • Consistency of service delivery
 • Services to remote areas
Referral
 • Open to registered health professionals
 • Acknowledging referral & informing
   patient
 • Training of referrers
   – Basic referral skills, measurement etc
   – Advanced referrers, capable of specifying
     basic chair
 • Integration with care pathways in rehab &
   acute services
 • Electronic route for referral via secure
   email / web form in first instance
Assessment & Delivery

 • Standardised assessment tools
    – Develop in parallel with National programme
    – Paediatric / Power / Manual
 • Feedback of Assessment outcome
    – standardised “tick-list”
    – develop custom letter based on assessment tools
 • Facilities
    – Many problems identified but action limited by current
      building
    – Clinic store for shared resources
Assessment & Delivery

 • Patient Transport
    – Most late or over-run appointments due to ambulance
      transport problems
 • Carer needs
    – Develop communications with care managers to identify
      carer needs before assessment
    – Document carer issues in assessment report
 • Standard documentation packs to be issued at point
   of equipment delivery
    – User instructions for pelvic belts etc to be developed
 • Training programme needed for carers on
   principles of positioning in seats
Capacity
 • Waiting lists currently around 23 weeks!
 • Priorities
     – Patient safety / breathing / feeding / skin breakdown
     – 1st issue of wheelchair
 • Waiting list “Blitz” planned for late June
 • Use Bioengineer to cover multiple OT-led clinics
 • Technician on standby for clinic support
 • Create delivery appointment slots – shorter
   duration than assessments
 • Create third clinic room to accommodate
   increased staffing
 • Create auxiliary post for clinic support
     – Personal care / hoisting / user instruction
Equipment
• Problems with “lightweight” chairs
   –   Durability of components
   –   Rubix / Basix problems
   –   Role of Dash Lite and Action 2NG
   –   Required feature set for occasional user and fleet chairs
• Configured manual chairs
   – Action 3 / Rubix
• Paediatric chairs
   – Standardise on Action 3 Junior but maintain pressure on
     manufacturers for alternatives
   – Cost of harnessing & alternatives to Bodypoint
Equipment
• High-end Manual
  – Standardise on K series, XLT, Neon (+Argon if req’d)
  – Standard specifications agreed
• Power
  – Mirage remains main fleet chair
  – Pride chairs used where mid-wheel drive required (but
    concerns about some aspects of company)
  – Spectra Plus and Salsa where tilt / seating / modified
    controls required
  – Need for powered recline / powered ELR / riser
  – Role of attendant controls
Equipment
• Cushions
   – Range of types and sizes of stock cushions required
   – Role of Roho Harmony and Jay Easy cushions
• Back supports & seating systems
   – Protech remains most cost-effective system for back
     support but will look again at Jay 3
   – Cost of configured manual chair with back support &
     cushion is similar to Rea Azalea – review practice
   – Improve system for storing and recycling Protech
     components
• Increase consistency of prescription and control
  costs
Finance

 • Overview of NHS Grampian financial position,
   cost pressures and efficiency saving targets –
   need to control costs
 • Costs of Orkney & Shetland services are
   disproportionate – increase monitoring &
   discuss with island Boards
 • SLA with Highland – bring back into Moray
   clinic
 • Improve monitoring of spend and
   communication of financial position to all staff
    – Use ReTIS as purchase ledger until new version
      implemented
Technical Services

 • Joint working with Aberdeen /
   Aberdeenshire & Moray Council services to
   uplift & decontaminate used equipment
 • Training of specialised technicians – setting
   up seating systems & power chair controls
 • Improve stock management
 • Implementation of PPM – agree protocols
   with manufacturers and other Scottish
   services
 • Encourage drop-in repairs
Island Services
 • Improving communications
 • Referral information
 • Scope and implementation of local services
 • Skill set required from local staff and
   training implications
 • Implementing PPM – local and visiting
   technicians
 • Clinic facilities required
 • Timescales for island clinics
Other issues
 • ReTIS database issues
    – Access from peripheral / island clinics
    – Synchronisation with mobile users
    – Delays in upgrade to current version
 • Possible use of Tablet PCs for note-taking,
   preparing assessment reports etc in clinic
 • Develop database of standard CAD drawings
Conclusions
 • Productive exercise to re-examine all aspects
   of service process
 • Identified many aspects of service which we
   do well
 • Local Action Plan
 • Follow-up events – late July / November
    – Include other stakeholders

								
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