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GM Spasticity - Clinic Audit
Clinical Organisational Audit Tool
(Please complete one form only per service)
Clinic Name/Location
(Required)
Trust responsible for Team
(Required)
Bolton
MFT
NCA
Stockport
Stoke
Tameside
WWL
Clinic coverage
Locality only
Wider afield
Clinic access criteria
All patients referred spasticity
Stroke patients only referred spasticity
Is the clinic run on a tariff or a block contract?
Tariff
Block Contract
Frequency of the clinics
(Required)
Please note the number held and then choose the frequency
Frequency of the clinics
Per Week
Per fortnight
Per Month
Per 6 weeks
Length of clinic
1 PA
2 PA's
Number of NP slots
Number of RV slots
Length of appointment time - NP
30 Mins
40 Mins
45 Mins
60 Mins
Length of appointment time - Review
15 Mins
20 Mins
25 Mins
30 Mins
Do you have waiting list access? (If no - could you seek internally whom may have before submission)
Yes
No access
How many patients are on the waiting list on date of clinic review? NP
How many patients are on the waiting list on date of clinic review? Reviews
Longest Wait Time
Average Wait Time
Is there an option for community visits from this service?
Yes
No
No but Clinic works with CSNRT to provide community support
If yes, which members of the MDT sit within the clinic?
Choose multiple as required
Rehab Medicine Doctor
Non-Medical Injector
Physiotherapist
Occupational Therapist
Nurse / HCA
Orthotist
Other (please state below)
If other - please give details
Who completes triage process for this clinic:
Choose multiple as required
Rehab Medicine Doctor
Non-Medical Injector
Physiotherapist
Occupational Therapist
Nurse
Other (please state below)
If other - please give details
Does the the clinic environment meet the needs of the service (i.e. space/equipment/hoists)?
Yes
No
If no, what needs are not met ( drop down) space, equipment, hoists
Are support staff available to assist with transfers/ moving and handling requirements?
Yes
No
Occasionally
If answering occasionally above - please document any issues
Is there a coordinated MDT for managing spasticity within the locality?
Yes
No
No but clinic works in collaboration with CSNRT
No but no CSNRT availability in the area
Is the service able to offer the following first-line interventions?
Advice on self/care management
Management of triggers/aggravating factors
Yes (within the clinic)
Yes (external to the clinic)
No
No but no pathway in place to access therapy review
No but no therapists in clinic
No but no coordinated working with CSNRT
Postural management
Yes (within the clinic)
Yes (external to the clinic)
No
No but no pathway in place to access therapy review
No but no therapists in clinic
No but no coordinated working with CSNRT
Therapeutic Management
Yes (within the clinic)
Yes (external to the clinic)
No
No but no pathway in place to access therapy review
No but no therapists in clinic
No but no coordinated working with CSNRT
Is the service able to offer the following second-line interventions?
Splinting/Casting/Orthotics
Yes (within the clinic)
Yes (external to the clinic)
No
No but no pathway in place to access therapy review
No but no therapists in clinic
No but no coordinated working with CSNRT
Oral Agents
Is other medication e.g. pain medication reviewed within the clinic?
Yes
No
Other
Botulinum Toxin
Which healthcare professionals deliver botulinum toxin in your locality?
Rehab Medicine Doctor
Non-Medical Injector
Stroke Consultant
How many injectors per clinic? (Please state whether they are medical or non-medical injectors.)
Number of medical injectors
Number of non-medical injectors
If any of the injecting clinicians are non-medical injectors, have they completed the following training requirements stipulated by the national guidelines:
a) Attended a botulinum toxin training course
Yes
No
N/A
b) Been observed assessing and injecting a minimum of 5 pts with arm and 5 pts with leg spasticty related problems?
Yes
No
N/A
c) Been trained to use the relevant equipment e.g. EMG, nerve stim or ultrasound (Please state which)
Yes
No
N/A
If yes - please state which
Is there access to mentorship for non-medical injectors within the clinic?
Yes
No
No but mentors have no availability
No but no trained mentors in locality
Is there access to EMG/Muscle stimulation/Ultrasound equipment as required?
List below
Yes
No
No but equipment has been ordered
No but equipment can be borrowed from other services
No but another localisation method is utilised
If yes - please state which
a) Which is most frequently used in clinic?
EMG
Muscle Stimulation
Ultrasound
Is there an onward referral route to facilitate:
Therapy review at 7-14 days post-injection?
Yes (within the clinic)
Yes (external to the clinic)
No but no pathway in place to access therapy review
No but no therapists in clinic
No but no coordinated working with CSNRT
Unknown
MDT review at 4-6 weeks post injection?
Yes (within the clinic)
Yes (external to the clinic)
No but clinic waiting times
No but no MDT in clinic
No but no pathway in place for coordinated working with CSNRT
Unknown
If yes, please give further info as to what this pathway looks like.
Are there pathways in place to access third-line interventions outside of the ward?
a) Intrathecal baclofen service
Yes
No
No but no pathway in place to access ITB clinic
b) Neurosurgical options
Yes
No
No but no pathway in place to access neurosurgical services
c) Orthopaedic/plastic surgery
Yes
No
No but no pathway in place to access orthopaedic surgical services
d) Sativex Clinic
Yes
No
No but no pathway in place to access sativex service
No but no sativex service in place
Does the service routinely provide written information to patients and carers on managing spasticity?
Yes
No
No but planning to utilise the GMNISDN leaflet
No but planning to use another piece of written information
If so, please share what information is given to patients
Thank you for completing the survey
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