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Developing relapse services

Managing MS relapse guide

Our relapse services guide was developed with an expert reference group of MS specialists.

The resources for developing and improving relapse services cover three main areas:

  • understanding relapse – what it is, why it happens
  • clinical management of relapse
  • eight steps to best practice in relapse management.

The way relapse services are configured varies widely across the UK. Some services are based in specialist MS centres, others in the community; some cover very urban areas, others are very rural. Each has its own challenges. Most services deliver care using a combination of telephone and clinic appointments.

Our eight steps to improving your relapse service have been written in such a way that they can be applied to any MS service.

Eight steps to improving your relapse service

Step 1: Educating health professionals

Goal: The healthcare team working with people with MS understand what a relapse is, what to do if a relapse is suspected, diagnosing relapse, potential treatment options and the configuration of local services.

Step 2: Educating people with MS

Goal: People with MS should understand the need to report all possible relapses and the MS team need to ensure that relapses are recorded accurately in the patient’s medical notes.

Step 3: Ensuring a responsive first point of contact

Goal: There should be a responsive, single point of contact for people to call if they are experiencing acutely deteriorating symptoms.

Step 4: Providing timely, effective triage and assessment

Goal: Triage should be carried out as part of the conversation when someone first contacts the service to report symptoms and should take place within no more than two working days of the first contact from the person with MS. Assessment should be provided within one week of the initial patient contact. This should be carried out face to face if at all possible by an experienced MS specialist nurse or neurologist.

Step 5: Providing timely treatment if required

Goal: Treatment which may be required for people experiencing a relapse should be offered within two weeks of the onset of their symptoms and ideally within 48 hours of the assessment.

Step 6: Following up relapses consistently

Goal: People who have received any treatment or have experienced a clinically significant deterioration should be offered a face to face follow up appointment within six-eight weeks of the assessment. The appointment should be booked and given to the individual at the time of their assessment. They should also be advised how they can contact the service in the meantime if they have any concerns or questions.

Step 7: Reviewing disease modifying drug management

Goal: Relapses are a signal of disease activity and should serve as a flag for review of the individual’s current DMD management.

Step 8: Auditing your service

Auditing your service allows you to pinpoint which aspects of the service are meeting standards and which (if any) are not. This allows you to focus on the aspects of the service which would most benefit from improvement.

Download our relapse service guide

Download our Eights Steps to Improving Your Relapse Service (PDF 1.2mb) or order a printed copy of the guide.

Further relapse materials

The following materials have been contributed by, or based on, resources used in practice by MS teams around the UK who kindly contributed them to the project. You are welcome to download and adapt them for local use.

Assessment prompt for people with MS ringing the service with suspected relapse (PDF 219kb) A double-sided one-pager which could be kept by the phone to act as a prompt to ask relevant and helpful questions for people with MS calling the service with acute deteriorating symptoms or suspected relapse to determine the best course of action. One side consists of questions to ask during initial triage and the other consists of a clear definition of relapse and the different phenotypes. (If you would like an editable Word Doc version of this resource, please get in touch.)
Relapse information for GPs (doc 28kb) Text which could be used to create a letter or leaflet to ask a GP to prescribe steroids
Information on steroids for people with MS (doc 28kb) Text which could be used in a local leaflet or information sheet for people with MS who have been prescribed steroids
Fold-out card for people with MS (PDF 382kb) An example of a fold-out credit card style information resource developed by Natalie Thomspon and Emily Whisker, MSSNs, for people with MS to keep handy. An editable fold-out card (doc 218kb) for health professionals who wish to use this card and tailor it to their own service is available. Note: the contact details for the service (on the final page) and NHS Trust logo will need to be personalised

Resources to signpost people with MS to

Symtrac An app to enable people with MS to track their symptoms, including potential relapses
MS Trust relapse information Our A-Z entry on relapse for people with MS
MS Trust symptom diary information Our A-Z entry on keeping a symptom diary and how this can help

Useful links to practice development resources


MS nurse professional: an online training resource

BMJ learning module on relapse in MS (BMJ subscription needed)

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