Service improvement: Implementation of non-motor symptom questionnaire

Rationale

In North Somerset Parkinson’s provision consists of outpatient appointments at Weston General Hospital (two consultants), a specialist nurse at Weston General Hospital (who provides limited support to community patients), and a vacant community specialist nurse role.

In theory implementation of the NMS questionnaire will allow patients to get the most from their appointments, will allow clinicians to be as efficient as possible, and provides a more standardised structure across services.

Preparation and implementation

I reviewed the existing evidence and discussed the initial idea with my Parkinson’s Academy Mentor. I gained approval from R&D at Weston General Hospital and discussed with consultant colleagues and specialist nurses.

The tool was implemented in an outpatient clinic at hospital while patients were waiting:

• Week 1: Questionnaire with Pharmacist support
• Week 2: Questionnaire alone
• Week 3: No questionnaire

Initial feedback and limitations

• Very useful
• Patients brought up more symptoms
• Patients more aware of condition
• Consultation was more efficient
• Patient’s commented that it was helpful
• Clinic appointments not long enough to go through questionnaire
• Most efficient when pharmacist available to explain to patients
• Specialist nurses not available to take part in pilot

Future development

A second phase will include: getting R&D approval for gaining patient perspectives, to post the questionnaire out along with the clinic appointment confirmation, and to have the specialist pharmacist present at clinic to interview patients post-consultation. I will discuss implementation with the new specialist Parkinson’s HCP, and discuss the possibility of altering clinic appointments (this request has already been made to hospital management).

2016 update

Since completing the pilot we have successfully recruited to the Specialist Health Care Practitioner role a physiotherapist who is currently getting to grips with her new role, meeting patients and dealing with the back-log that was established as the previous two position holders had left after six months.

Our new physiotherapist uses the NMS questionnaire as part of her standard assessment with all patients to get to grips with their current condition. It also allows her some structure and she feels it is helping with her development and understanding of PD beyond the motor symptoms that she is more familiar with as a physiotherapist.

We also have the addition of two part time mental health nurses who have previously worked in integrated care and can bring another dimension to the current team. They have been able to offer support to both patients and carers where appropriate. They are able to link patients to the volunteers and charity organisations based on the needs identified through the NMS questionnaire, beyond just questions about mood.