Barry

This case study is an example of specialist knowledge and intervention by Sarah Watson, Leeds.

Barry is 70 and was diagnosed with secondary progressive MS in 1991. He lives with his wife, Sheila, in an adapted property. Sheila manages all of Barry’s cares. He is hoisted for all transfers and is a full time powered wheelchair user. They do not have a care package, but Sheila has a few hours of respite once a month. 
 

• Barry struggles communicating, often resulting in slow or slurred speech (dysarthric). Consequently, he has installed an app called EVA facial mouse on his laptop which uses eye gaze to control the mouse and enables him to continue to use his laptop.
• Barry has chosen to eat and drink independently despite having an unsafe swallow. He is aware of the risks and does not want a feeding tube. 
• An ADRT (Advanced Decision to Refuse Treatment) has been agreed with Barry. He has documented his preferences to not be admitted to hospital.
• AMSC received a call from Sheila. Barry had three days of multiple episodes of diarrhoea, following a two-day period of constipation. 

• Urgent referral to Community Continence team.
• Contact made with Specialist Continence nurse to ask for management advice.
• Urgent GP home visit to carry out examination to check for bowel obstruction. 
• The AMSC coordinated care about medical management and supporting Sheila with delivery of this new plan.

• GP assessment led to an updated management plan, including ongoing intervention from the continence nurse. 
• A reduction in episodes of incontinence.
• Carer stress significantly reduced and Sheila feels more supported.
• Increased care support offered. The couple know this offer still stands for the future.