Working within a multidisciplinary team has great advantages when aiming to provide a service to people with learning disabilities.
It means there is an enormous wealth and breadth of knowledge, experience and training at your fingertips. A simple conversation with a team member can shed an abundance of light on an issue or case; it enables you to see things from another perspective, to truly think outside the metaphoric box (or even, to keep thing from boxes at all). When professionals work well together it can create a seamless service and I am a firm advocate of understanding the roles and remits of those around you as I believe it can only lead to improvements in your own practice. In fact, spending time with the learning disabilities psychology practitioner has made an indelible impression on the ways in which I will approach my practice in the future.
This week, I attended the epilepsy clinic with my mentor and consultant psychiatrist. The monitoring and management of epilepsy in people with learning disabilities is a key role of the community learning disabilities nurse as around half of people with learning disabilities have epilepsy. Something I found encouraging was the fact that the psychiatrist sought and valued the opinion of the learning disabilities nurse; so often we hear tales of a ‘doctor knows best’ attitude. Patients attended their appointments with the support of family or paid carers and were asked about the frequency and type of seizures they had experienced since their last visit to clinic as well as the affects of current anti-epileptic drugs. The nurse and psychiatrist ensure families and staff teams are aware of possible interactions between anti-epileptic and anti-psychotic medication (both used regularly in people with learning disabilities). Some people who have seizures require the administration of rescue medication, such as midazolam or diazepam. The community nurses regularly deliver epilepsy training sessions to family and carers so that they can safely and confidently administer these drugs. It is not unheard of for such medication to be used inappropriately so the health team issue as-required medication guidelines, which are to be adhered to.
A patient attended the clinic accompanied by two members of their staff team and we were informed that the as-required diazepam had been used during the previous week as the result of a seizure. When asked for a description of the epileptic event, the staff stated that they were not present and the seizure recording log was at home. I arranged to call out for a home visit later that day to collect the additional information. I needn’t have bothered, really, as the extent of the diary entry was as follows: “**** was jerking in the chair so diazepam administered”. There was no indication of the time of day, let alone the type or duration of seizure. This led me to believe that perhaps they had failed to follow the previously issued guidelines. There appeared to be no explanation for this other than a lax approach to the work they were commissioned to do. When I spoke to a physio technician, she told me how there have been many occasions when the team has dedicated a great deal of time and effort to creating and delivering treatment programmes for people with learning disabilities, only to have their efforts hampered by staff teams not complying with the guidelines in their absence. Her main area for concern was around the appropriate positioning of people in chairs and how staff appeared to pay little attention to this, despite being aware of how important it is to maintain and protect people’s posture.
I find it quite disappointing that the ground level care staff don’t always see the significance of their position. I understand that they often work long hours with scant amount of appreciation, and that they do this mostly for little more than the national minimum wage. Even so, I find it hard to justify them cutting corners, especially when this often has such negative consequences for the people in their care. How can we help people realise that even the smallest cog can bring the whole machine to catastrophe if it’s not working properly? From assisting the washing and dressing of someone in care to prescribing medication – every action, every day, however small, has the potential to have a powerful and lasting affect on the lives of the people in receipt of our care.
Claire Harries is Student Nursing Times learning disabilities branch student editors