NT: How did you get involved with creating the care bundle?
NB: The CNO launched the 10 high impact changes to improve care – and number six was to develop integrated care bundles to enable gold standards of care. We already had ones for ventilation and tracheostomy and the North West Midlands Critical Care Network decided to develop a care bundle for the management of the acutely spinal injured patient within critical care.
Patients were come to us with massive pressure sores because they did not know how to position them within ITU or in A and E.
NT: Were there any other common problems?
NB: Patients were coming to us who had spinal clearance. Patients were being seen by A&E doctors or senior house officers who did not have the right orthopaedic or spinal knowledge.
We were seeing patients who had got spinal injuries even though they had spinal clearance. We had a whole spate of them.
NT: What happened next?
NB: We were going to do a spinal care bundle anyway. A multi-disciplinary team of spinal surgeons, anaesthetists from the network…all agreed we would go ahead and do it. My colleague Alison Lamb, another nurse consultant, was also involved. Now every hospital in out network has the bundle. The West Midlands network wants to use it and we are going to Leicester and East Anglia to as they are interested in it.
NT: What kind of recommendations does the care bundle make?
NB: We would like to get patients off the spinal boards – that is what nurses don’t realise. One patient spent a year and a half in hospital because nurses had not had the correct training in moving and handling.
Overall the bundle covers management of acutely spinal injured patient, spinal clearance and referral to specialist and care in the ITU and H