Spasticity Management Service · Spasticity Management Gary Morris Advanced Physiotherapy...
Transcript of Spasticity Management Service · Spasticity Management Gary Morris Advanced Physiotherapy...
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Independent Prescribing in Spasticity Management
Gary Morris Advanced Physiotherapy Practitioner: Neurological Rehabilitation Glangwili General Hospital, Carmarthen Associate lecturer – Cardiff University
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Plan
• Overview of spasticity management
• Physiotherapists & medicines
• Developing a service
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Who does spasticity effect?
Stroke 54%
MS 20%
Spinal cord injury
8%
Traumatic brain injury
8%
Cerebral palsy 4% other
6%
Primary diagnosis of (non-LD) adults attending Carmarthenshire spasticity management service
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What problems does it cause?
Spasticity
Skin damage
Difficulty with function
Pain Contracture
Restricted movement
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Spasticity Management
Physical management
Medical management
Oral agents Intra
muscular agents
Intrathecal agents
Surgical management
Adapted from: Royal college of physicians et al (2009)
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Therapists Patient Carers
Spasticity Management
Physical management
Medical management
Oral agents Intra
muscular agents
Intrathecal agents
Adapted from: Royal college of physicians et al (2009)
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Assessment
• Diagnosis & history
• Aggravating factors
• Severity
• Distribution
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Physical management
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Therapists Patient Carers
Doctors
Spasticity Management
Physical management
Medical management
Oral agents Intra
muscular agents
Intrathecal agents
Adapted from: Royal college of physicians et al (2009)
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Physiotherapists & medicines
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Medicines
Administering
Patient specific direction (PSD)
Patient group direction (PGD)
Non medical Prescribing
Supplementary Prescribing
Independent prescribing
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Administering
Spasticity Management
Physical management
Medical management
Oral agents Intra
muscular agents
Intrathecal agents
Adapted from: Royal college of physicians et al (2009)
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Medicines
Administering
Patient specific direction (PSD)
Patient group direction (PGD)
Non medical Prescribing
Supplementary Prescribing
Independent prescribing
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independent prescribing
“…prescribing by a practitioner responsible and accountable for the assessment of patients…and decisions about the clinical management required, including prescribing”
(Human Medicines Regulations, 2012)
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What can physio’s prescribe?
• “…may prescribe any licensed medicine from the BNF” (apart from controlled drugs)
• “…for any condition within the practitioner’s area of expertise and competence”
• “…within the overarching framework of human movement, performance and function”
Chartered Society of Physiotherapy (2013)
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Training
• At least 3 years of post grad experience & working in an area of advanced practice
• Up to 1 year part-time to train
• Minimum 38 days to include
– 26 days in University
– 12 days in mentored clinical practice with a designated consultant/GP
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Training themes
• Initial clinical assessment • Communication • Knowledge of medicines • Evidence based practice • Clinical decision making • Shared decision making • Care planning and follow up • Documentation • Legal & ethical issues • Scope of practice • Continuing professional development • Prescribes safely • Public health issues relating to prescribing • Complying with healthcare policy
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Independent prescribing
• Subject to the same competency framework as all prescribers
National Prescribing Centre (2012)
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Independent prescribing
Adapted from: Royal college of physicians et al (2009)
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Case study
• 24 yr old lady seen in Neuro outpatients
• Diagnosis: incomplete T5 SCI following removal of a vertebral tumour
• Presenting with:
– Clonus in ankle during weight bearing limiting progress with rehab
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Developing a service
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Get a doctor on board
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Train as an injector
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Prescribing solution
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Medicines
Patient specific direction (PSD)
Patient group direction (PGD)
Independent prescribing
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Support from pharma?
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Sell the benefits
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Conclusion
• Many people with long term neurological conditions will need a combination of physical and medical management to meet their needs
• Physio’s working in advanced practice are in a key position to meet these needs as prescribers
• Within spasticity management there is
experience, guidance & evidence available to support you to develop these roles
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References • Chartered Society of Physiotherapy (2013) Practice guidance for
physiotherapist supplementary and/or independent prescribers in the safe use of medicines, 2nd edn. http://www.csp.org.uk/documents/pd026-practice-guidance-prescribers?networkid=226227
• Human medicines regulations (2012) http://www.legislation.gov.uk/uksi/2012/1916/pdfs/uksi_20121916_en.pdf
• National Prescribing Centre (2012) Single competency framework for all prescribers. http://www.npc.co.uk/improving_safety/improving_quality/resources/single_comp_framework_v2.pdf
• Royal college of Physicians, British Society of Rehabilitation Medicine, Chartered Society of Physiotherapy, Association of Chartered Physiotherapists Interested in Neurology (2009) Spasticity in adults: Management using botulinum toxin: National guidelines. https://www.rcplondon.ac.uk/publications/spasticity-adults-management-using-botulinum-toxin
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Bibliography
• Chartered Society of Physiotherapy (2013) Medicines, prescribing and physiotherapy, 3rd edn. http://www.csp.org.uk/documents/pd019-medicines-prescribing-physiotherapy-3rd-edn?networkid=226227
• Healthcare Professions Council (2013) Standards for prescribing. http://www.hpc-uk.org/aboutregistration/standards/standardsforprescribing/
• Ben Goldacre (2013) Bad pharma: How medicine is broken an how we can fix it. 4th estate publishing, London
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NHS: [email protected] Cardiff University: [email protected] Twitter: @Gary_y_ffisio