Throughout health boards in Scotland, it is no secret that diagnostic times are lengthy and vary depending on where you live. Some can take up to 3 or 4 appointments and times vary from 8 weeks to over 12 months. This can be very stressful for all involved.
We know that evidence shows a better outcome for people who receive a diagnosis of Dementia earlier. We know that people live well for longer when supported. Yet we still have a huge waiting list to tackle.
How can we improve this with a shortage of doctors? How would you feel about receiving a diagnosis from a masters qualified NURSE?
Learning in Practice
In an are in Lothian in 2019. A post was created for a trainee advanced nurse practitioner to work within the memory clinic. The nurse completed training through 3 masters modules, including advanced patient history taking (the important part) being able to assess you holistically and to rule out all other causes that can impact on cognitive problems. What has changed for you and your loved ones? Functionally, emotionally and how is that impacting on your life?
Work based learning module – To learn to read bloods, ECG’s and scans and assess the person fully and finally non-medical prescribing. Being able to prescribe the medication you require if suitable at point of diagnosis. The nurse was heavily supervised by psychiatrists, neurologists and geriatricians. She quickly became competent in the role, with years of dementia practice before in wards and in the community as a community mental health nurse.
From a plan to training to Action
On qualifying from university, the nurse then began nurse led diagnostic clinics. Fully autonomously. Receiving the referral from the GP and a full assessment from the community nurses she would hold clinics twice weekly and complete home visits the remaining two days. Seeing over 20 people a week for assessment and diagnosis. There were referrals completed to psychology or allied health professionals if required but this was fully nurse led from the assessment to formulating the diagnosis, prescribing and arranging post diagnostic support.
The team with this post in place were able to bring the diagnosis waiting times down from 12 months to 4.2 months. Allowing people more timely diagnosis and quicker treatment plans and support. The nurse also completed a capacity and consent course and was able to order and read CT, MRI and DAT scans of the brain.
What’s next?
The model has been adopted and currently in place in other areas of Scotland. But has this been adopted and utilised quick enough? Despite the evidence and data collected, this is still a rare model of practice for dementia diagnosis.
We continue to promote the pathway, and the hope is that each health board will consider adopting a nurse led diagnostic clinic into their area too.
Final thoughts?
This model has been in place now for almost 6 years and the diagnostic times in this area continue to be stable. The feedback received from individuals who have received their diagnosis this way has been heartfelt and positive. This is a cost effective and patient centred way of thinking outside the box to improve on diagnostic waiting times.
The cost implication is relatively low with upskilling the nurse and it also allows for clinical career progression for nurses, whilst directly impaction on waiting times for people waiting on a diagnosis of dementia, when we know this can be a timely, confusing and difficult time for the individual and their loved ones.
At the heart of all of this is one simple fact:
When we have timely access to diagnosis and support, the outcome for the person and their loved ones improve and that is truly what matters.
So…. Would you be happy to accept a nurse led diagnostic appointment?
Contributor. Mel Rowlands, Nurse consultant in Dementia, NHS Lothian
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