Planning for care outside the
Jean Buchanan, community
liaison sister, Weston Park
NICE clinical guideline 75 (2008)
• Discharge planning and ongoing care, including
rehabilitation for patients with MSCC, should
start on admission…….It should involve the
patient and their families and carers…….
Holistic assessment takes time
• diagnosis of spinal cord compression is a life
changing event. “With a one year survival rate of less
than 20% ,the majority of patients with MSCC must
manage both disability and the implications of life limiting
Eva G. Paley J, Miller M, Wee B; Palliative Medicine 2009: 23 “Patient’s
constructions of disability in metastatic spinal cord compression”
• It may be the presenting symptom of cancer.
• Balancing patient’s need for time to adjust to
their situation against pressure on inpatient
Will I walk again?
Will I be able to go home?
What happens if I can’t?
What options are available on
• Transfer back to local hospital
• Admission to a specialist rehabilitation unit
for people who are most likely to benefit
(NICE clinical guideline 75)
• Nursing home
• Return home
What support may be available at
• Informal carers
• Social services
home care, equipment & adaptations
• Health services
Community & palliative care nurses, night care,
“hospice at home”, nursing equipment, home care
• Third (voluntary) sector services
• Charities e.g Macmillan, welfare rights advice,
Services differ between areas –postcode lottery?
Will I have to pay for my care?
• Patients should be assessed against continuing
healthcare criteria Depending on level of need either
social services, health service or a joint package
• The WPH spinal cord compression audit indicates that
patients with little or no mobility post treatment are likely
to have a poor prognosis and should therefore meet the
continuing health care fast track criterion:
“A primary health need arising from a rapidly
deteriorating condition which may be entering a terminal
phase, with an increasing level of dependency” this
should help meet the NICE guidelines that “care and
equipment is provided in a timely fashion”
• “good communication with the patient
cannot happen unless it exists between all
members of the MDT”
• Purdue C. (2004) Nursing Times 21/09/04 “Diagnosis and treatment
of malignant spinal cord compression”