Our report Improving the Efficiency of DMD Provision outlines how DMD management and monitoring can be improved and modernised, and makes a number of recommendations.
Roles needed in MS teams
The report recommends that, for efficient practice, not everything should be done by MS specialist nurses. There is a role for DMD/Therapies nurses, DMD coordinators (or combined MS and DMD coordinators in smaller teams), and an increased role for pharmacists and pharmacy technicians.
The Poole Hospitals service has developed a model job description for an MS and DMD coordinator (doc 108kb) based on an original used in Cardiff.
Our practical resources on capacity planning and business cases provide tips on making the case for new staff.
Enablers to efficient practice
The report recommends that DMD services should have:
- a lead for the DMD service, responsible for ensuring that monitoring protocols and systems are in place and are adhered to
- clearly defined pathways and processes for DMD delivery and monitoring
- information systems which allow them to keep track of everyone on treatment (including those whose treatment is monitored in ‘spoke’ teams)
- multidisciplinary team meetings to make decisions about treatment at individual patient and service level.
Reducing unnecessary face-to-face appointments
The report highlights that in many cases, people with MS on DMDs are having a specialist consultation every time their bloods are monitored. Some of these reviews are important, but some may be wasteful and reduce the availability of specialist input for people who are not on DMDs.
Involving people with MS on DMDs in their own care
The report recommends involving people with MS in understanding their own DMD treatment and monitoring through:
- having clear, shared expectations up front about what will be required – not only for treatment but also for monitoring
- encouraging people with MS to use the MS Decisions tool and then talking through the results with them can help.
- using treatment agreements
- keeping people informed about their results: patient portals which allow patients to log on and view their own records can be helpful.
Examples of how teams have implemented efficiencies in their DMD services are featured in our case studies of innovative practice in MS services.