MS Nurse MDT Referral Template

Introduction:

Multiple sclerosis (MS) is a chronic and progressive immune-mediated disorder of the CNS affecting around 2.5 million people worldwide. MS is a chronic, debilitating, and neurodegenerative autoimmune disease that attack the central nervous system (CNS). The autoimmune reaction causes scarring (sclerosis) of the nerve and interruption of the conduction of nerve impulses from the brain along the spinal cord and to the rest of the body. Because of the complex nature of MS and the wide range of symptoms and problems faced by patients with the disease, a comprehensive care team is required to provide the support needed for effective disease management. NICE guidelines clearly states that all patients should have access MDT.

NHS England states that patient safety is the avoidance of unintended or unexpected harm to people during the provision of health care and it supports care providers to minimize patient safety incidents and drive improvements in safety and quality.

Becoming an MDT co-coordinator immediately after joining the MS service with no prior experience as a MS nurse was daunting. Developing this template helped to assess patient’s need holistically and provide patient centred care.

Objectives:

1. To share developed clinical MDT template to help new and existing MS nurses and other health care professional.

Summary and key Points:

1. Obtain consent from patient for MDT.
2. The content and length must be succinct as possible.
3. Ensure to avoid jargon words, when letter is addressed to patient keep language simple and easily able to understand.
4. Provide brief patient past medical history, when symptoms started or noticed.
5. Include scans from previous hospitals please give ample time to retrieve these scans for MDT neuro-radiology review.
6. Please enter GP or other clinician details if any actions to be taken for e.g. vaccination, blood investigations, lumbar puncture.
7. Ensure MS service contact details are included in the letter for further support.
8. Letters are medico-legal document therefore ensure that the contents are factual. Any opinion gathered from other clinicians must be added in the outcome notes.
9. Please call patient and inform and explain the MDT outcomes in person either with MS consultant or MS specialist nurse.

Service Development:

1. We (I and my MS consultant) liaised with the Royal London Hospital MDT coordinator and improvised the MDT referral template 6 months ago for new patients awaiting diagnosis and for those requiring switching or stopping DMD’s.
2. As a new member in the MS service this template had provided me with better knowledge and understanding on referring patient to the MDT.
3. This template helped to avoid repeated errors and duplication of work in turn which helped the busy service to focus on patient care.
4. It helped to reduce delay in initiating /switching or stopping DMD which is vital part in MS treatment.
5. Helped to effectively communicate the MDT outcome between the MS team members and also provided an updated plan to the patient’s GP services that play a vital role in their treatment.
6. It also helped to provide prompt feedback on the MDT outcomes to the patients and their family members so as to avoid delay in commencing/changing/stopping their treatment.
7. Introducing this template helped to build a culture of safe referral in our MS service.

Conclusion:

A coordinated multi-disciplinary team or MDT is vital for someone living with a long term condition like MS. We had a separate MDT folder in our shared drive with patients names who need to be discussed on priority basis, patients who were already discussed and patients awaiting investigations or scans which helped the team to access in the absence of other members.

Our MS service found that designing this referral template improved communication and enabled effective patient care based upon the needs of the individual patient. Designing this template increased flexibility to make changes and was easy to update as and when required.

References:

1. Ayer M (2018). Multiple sclerosis nurse led consultations: Evolution of clinic template. British journal of Neurosciences Nursing. Feb/Mar: vol 14(1)
2. Multiple sclerosis in adults: management clinical guidelines {CG186}
   {Accessed 25/10/2021}
3. Multidisciplinary team approach improves multiple sclerosis relapse care
   www.neurologyadvisor.com {Accessed 31/10/2021}
4. Stephen Ramsay et al (2021). The importance of neuro radiology input at a neuro inflammatory multidiscipline {MDT}meeting. Influencing and optimizing the management of patients with MS. Neurology; April 13(96): 15 supplement
5. MS TRUST.ORG.UK
   {Accessed 25/10/2021}