ABSTRACT
The demonstration of intrathecal baclofen (ITB) nursing competencies includes presentation of evidence that illustrates learning about the subject and skill development. This evidence can come from various sources:
A
Audit/data collection
O
Observation of practice
D
Documents: proposals, reports, strategies, standards, guidelines, policies and appraisals
L
Learning evidence: reflection, certificates, personal development plan, learning outcomes and study programmes
ITB Nurse Specialist
Evidence of achieving competence
Nurses role in managing spasticity
Demonstrate ability to be compassionate and supportive to people with spasticity (PWS) when dealing with their needs both in person and over the telephone.
Teach nurses and carers the basic neurophysiological principles underlying spasticity and other features of the upper motor neuron syndrome.
Teach a PWS and their carers about trigger factors that can increase spasticity and effective management techniques.
Discuss and be able to educate ward nurses and other healthcare professionals about the treatments for spasticity and the nurses role with:
Managing trigger factors
Stretching, hoisting and positioning
Oral drugs
Focal treatments
Generalised treatments
Be able to present on external courses to multidisciplinary audiences.
Spasticity assessment clinic
Within a multidisciplinary team, assess and appropriately select people suitable for ITB trial.
Without the need for supervision, be able to complete the initial teaching with individuals who are recommended for ITB therapy by the spasticity team and ensure the PWS has written information about ITB.
Post-clinic, commence admission and discharge planning processes by liaising with relevant hospital and community teams.
Arranging admissions
Continue with education of PWS by telephone, completing a preadmission assessment and highlighting any concerns, without the need for supervision.
Ensure all the necessary equipment is arranged for admission to the ward.
Act as a key worker for the PWS throughout the admission, discharge and follow-up process.
Arrange admission and liaise with appropriate hospital and community teams.
ITB trial
Carry out the following without supervision:
Continue spasticity assessment in the inpatient setting.
Complete spasticity measures with the physiotherapist. Demonstrate understanding of the significance of the measures and the importance of repeating them at peak effect. Monitor effect on person of being measured and document all measures in medical notes.
Together with the PWS and the team, agree on a goal of treatment. Demonstrate appropriate review of this goal after the trial.
Organise with the ward nurses the necessary equipment for the safe administration of the trial injection and to complete the observations following the injection (see care plans in Appendix 9).
Continue to observe the PWS post-injection and educate and support ward nursing team regarding trial processes and the acute period.
Support medical team in carrying out ITB trial injection.
Evaluate effects of the trial with PWS and team using both subjective and objective information collected during the assessment and measurement process.
Decide on future plan with multidisciplinary team and PWS.
ITB implant
Carry out the following without supervision:
Liaise with PWS and their carers regarding site for pump implant.
Continue education of PWS and reiterate implications (both positive and negative) of pump.
Liaise and coordinate with surgical team regarding site of implantation, equipment for implant and surgery time.
Liaise with the pump manufacturer representative to ensure adequate support during surgical procedure.
Ensure all post-trial documentation is accurately completed by doctor and baclofen concentration and starting dose is prescribed.
Attend theatre, ensuring all equipment required is available and working.
Record length of catheter removed during surgery.
Ensure venous thrombotic embolisation prophylaxis is prescribed (as per hospital policy).
With medical staff, calculate initial priming and starting dose. Programme pump whilst PWS is in recovery.
Describe your role, identifying boundaries and when and where you would seek help within the different phases:
Pre-operative
Peri-operative
Recovery phase
Post-operative care on the ward
Discharge planning
Discharge planning
Educate PWS and carer about pump alarm system and play alarms, explaining how and when to seek help.
Educate community teams about ITB therapy, potential side effects and procedure for getting help if problems occur.
Ensure essential information, including pump serial number, catheter details and length of catheter, are recorded.
Prepare joint report with therapy and medical teams.
Arrange follow-up telephone review 4 weeks after discharge to discuss general health, spasticity and pump effectiveness.
Arrange therapy and nursing outpatient appointment to review spasticity and pump effectiveness.
Record low reservoir alarm date and arrange refill visit with PWS.
ITB pump replacement
Carry out without supervision as for ITB implant, but in addition:
Monitor dates of potential replacements and prepare individuals for timing of replacement. Liaise with community teams, carers and family members as appropriate.
Update individuals on any changes in the technology of the replacement pumps.
Educate the individual on potential changes in their degree of spasticity management during the replacement phase.
Coordinating outpatient clinic
Carry out the following without supervision:
Manage appointments according to reservoir refill dates or at least 6 monthly.
Coordinate outpatient clinic and liaise with appropriate staff regarding transport, appointment times, etc.
Organise ITB prescriptions with pharmacy.
Organise emergency outpatient appointments if required.
Manage stocks of equipment: baclofen pumps, catheters, refill kits, syringes, gauze, plasters, needles, etc.
Be able to effectively programme the pumps (with a doctor) and maintain accurate records and printouts from the programmer.
Demonstrate competence at completing the pump refill procedure and effectively address pump problems and adverse events as they arise.
Educate new junior medical staff on all aspects of the ITB service, including how to use the programmer in both emergency and nonurgent situations.
Educate on-call medical teams as appropriate.
Managing the telephone advice line
Carry out the following without supervision:
Manage the telephone advice line by regularly checking it and taking appropriate action with calls.
Demonstrate clear clinical reasoning and action when dealing with adverse events that may be related to pump or catheter malfunction.
Educate the ward nurses to manage the advice line out of hours and to take appropriate action.
Educate the general practitioner or health professional about how to manage acute problems and take appropriate action.
If necessary, organise urgent outpatient appointments or admissions when spasticity symptoms occur or alarms sound.
Other
Manage stock levels of equipment and maintain accurate financial databases, ensuring that a clear financial audit trail for the service is available.
Ensure database of equipment (i.e. that is, serial numbers, product numbers and patient details) are accurate and up to date for use as a tracking system should equipment failure occur.
Signature of Nurse
Print name
Date
Signature of Assessor
Print name
Date
Signature of Manager
Print name
Date
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