An evaluation of the current assessment methods used within a District General NHS Trust spasticity service

Purpose

The management of spasticity in specialist clinic has not been evaluated objectively. One of the barriers to conducting an audit is the lack of a robust patient centred assessment framework. The aim of this study was to audit the existing patient notes and from this develop a patient centred assessment framework that provides objective data that can be used to audit the service.

Approach

The existing service assessment documentation from 50 patients was examined to create a list of the assessment methods currently used within this service and a thematic analysis was conducted to identify the primary patient problems.The form was then updated to to ensure only valid measures that documented a patient reported problem and information essential for diagnosis, prognosis or response to treatment were included.

Outcomes

Results: The original assessment form consisted of six pages where most measures lacked objectivity and validity. The assessment processes were not standardised and demonstrated that a battery of assessment measures were used. Whilst there was a documentation of problems central to the patient, these were not objectively assessed. As a result the updated form consists of 4 pages. The main issues identified by patients could be classified as: Pain, Spasms, Stiffness, and Activity (including quality of life and, passive and active function). An unintended consequence of this new form was that it has provided the basis of a treatment algorithm.

Conclusion(s): In a period where there is pressure on clinicians to be efficient , effective and patient centred, there is a need to ensure that the documentation is fit for purpose. The newly developed form is simple to complete and provides objective information that can be used to audit the current services. The updated assessment form and treatment algorithm can now be piloted.

Cost and savings

This project was undertaken as a requisite to completion of a Post graduate Masters qualification. Therefore was completed by the clinician as part of their study where the time used was their own with no costs to the trust. As the project is currently being piloted there is no further information available at this time for cost savings or increased productivity.

Implications

Clarity in the decision-making process gained by improving the assessment documentation, will aid clinical decision making and improve recording of treatment success and or adverse event for evaluating the service. By implementing the assessment algorithm, as documented within this study, it will ensure clear assessment, review and record of treatment success. This is essential for the auditing of services and in ensuring appropriateness of treatment.

Top three learning points

No further information. 

Funding acknowledgements

Not funded.