Quality statement 3: Provision of equipment and adaptions based on multidisciplinary team assessment | Motor neurone disease | Quality standards

Quality statement

Adults with motor neurone disease (MND) receive tailored equipment and adaptions without delay, based on regular multidisciplinary team assessments.

Rationale

People with MND can have multiple functional problems and may therefore have complex equipment needs that will change as MND progresses. Regular assessment by the MND multidisciplinary team can ensure the provision of equipment and adaptations is responsive to a person's changing needs. Providing equipment and adaptions without delay maximises the impact on the person's quality of life, allowing them to continue with usual activities and reduce the likelihood of harm from adverse events such as falls.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that adults with MND have regular assessments from MND multidisciplinary teams.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that equipment is provided, or adapted, in a timely way to meet the individual needs identified for adults with MND.

Data source: Local data collection.

Process

a) Of adults with MND, the number who have had a comprehensive assessment by the MND multidisciplinary team in the past 3 months.

Data source: Local data collection based on extracts from or reviews of individual care records. At provider or commissioning level, data collection will involve small numbers.

b) The length of time in days between an equipment need or an adaption need being identified in a comprehensive multidisciplinary team assessment, and the equipment being provided or adaption made.

Data source: Local data collection based on extracts from or reviews of individual care records. At provider or commissioning level, data collection will involve small numbers.

Outcome

a) Adults with MND able to maintain activities of daily living.

Data source: Local data collection. National data on whether people with MND feel that the equipment or adaption they are using meets their needs is available from the Improving MND Care survey from the Motor Neurone Disease Association (MNDA).

b) Adults with MND feel they are able to maintain their quality of life.

Data source: Local data collection.

c) Number of injuries to adults in the home associated with functions impaired by MND.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as MND multidisciplinary teams) ensure that they assess people's needs, including mobility and daily living needs and abilities every 2 to 3 months, and that services are integrated between providers so that equipment and adaptions can be provided to meet people's changing needs without delay.

Healthcare professionals and social care practitioners (such as members of MND multidisciplinary teams) ensure that they assess and anticipate changes in the person's needs, including mobility and daily living needs and abilities, every 2 to 3 months, and provide, or refer to services that can provide, equipment and adaptions to meet the person's individual needs without delay.

Commissioners ensure that they commission MND services in which MND multidisciplinary teams assess people's needs, encompassing mobility and daily living needs and abilities, every 2 to 3 months, and provide tailored equipment and adaptions without delay.

Adults with MND have regular checks to make sure that any equipment they have been given to help them manage their condition, such as a wheelchair, is still meeting their needs. These checks also help to anticipate any future changes in their needs, including whether any changes to existing equipment or new equipment will be needed. The checks should happen in appointments with a team of specialists called an MND multidisciplinary team (usually every 2 to 3 months).

Source guidance

Motor neurone disease. NICE guideline NG42 (2016), recommendations 1.5.3, 1.9.1, 1.9.2 and 1.9.6

Definitions of terms used in this quality statement

Tailored equipment and adaptions

Daily living aids, assistive technology and adaptions that can be integrated and adapted to meet the changing needs of the person with MND and their family or carers. Examples include wheelchairs, hoists, head supports, arm supports, riser–recliner chairs, drinking and eating aids, environmental controls, and home adaptions. [NICE's guideline on motor neurone disease, recommendations 1.9.5, 1.9.6 and 1.9.7]

Regular assessments

Assessments carried out by the multidisciplinary team every 2 to 3 months unless the person's symptoms and needs require more or less frequent assessment. Assessments cover the areas set out in recommendation 1.5.3 in NICE's guideline on motor neurone disease that include mobility and activities of daily living, communication, nutritional intake, swallowing, muscle problems, physical function, pain, respiratory function, cognition and behaviour, and social care needs.

Assessments include assessing and anticipating changes in the person's daily living needs, taking into account:

activities of daily living, including personal care, dressing and bathing, housework, shopping, food preparation, eating and drinking, and ability to continue with current work and usual activities
mobility and avoiding falls and problems from loss of dexterity
the home environment and the need for adaptations
the need for assistive technology, such as environmental control systems
a person's ability to use equipment.

[Adapted from NICE's guideline on motor neurone disease, recommendations 1.5.2, 1.5.6, 1.9.1 and 1.9.6]

Multidisciplinary team

An MND multidisciplinary team that:

includes healthcare professionals and social care practitioners with expertise in MND, including staff who see people in their home
ensures effective communication and coordination between all healthcare professionals and social care practitioners involved in the person's care (and their family members and/or carers, as appropriate)
provides coordinated care for people who cannot attend a clinic, according to the person's needs.

The core multidisciplinary team should consist of healthcare professionals and other professionals with expertise in MND, and should include:

neurologist
specialist nurse
dietitian
physiotherapist
occupational therapist
respiratory physiologist or a healthcare professional who can assess respiratory function
speech and language therapist
a healthcare professional with expertise in palliative care (MND palliative care expertise may be provided by the neurologist or nurse in the multidisciplinary team, or by a specialist palliative care professional).

The multidisciplinary team should have established relationships with, and prompt access to:

clinical psychology and neuropsychology
social care
counselling
respiratory ventilation services
specialist palliative care
gastroenterology
orthotics
wheelchair services
assistive technology services
alternative and augmentative communication (AAC) services
community neurological care teams.

[NICE's guideline on motor neurone disease, recommendations 1.5.2, 1.5.4 and 1.5.5]