Guideline for the referral of Paediatric Back Pain to the Physiotherapy Service V2.0. May 2015

Transcription

1 Guideline for the referral of Paediatric Back Pain to the Physiotherapy Service V2.0 May 2015 Page 1 of 12

2 Table of Contents 1. Purpose of this Guideline Scope Definitions / Glossary Ownership and Responsibilities Role of the Service Lead Role of the Physiotherapy Staff Role of Individuals referring patients into the service Standards and Practice Dissemination and Implementation Monitoring compliance and effectiveness Updating and Review Equality and Diversity... 7 Appendix 1. Governance Information... 8 Appendix 2. Initial Equality Impact Assessment Form Appendix 3. Reference List Page 2 of 12

3 1. Purpose of this Guideline 1.1. This guideline is for use by health professionals to ensure referral of children with back pain to appropriate services This guideline applies to anyone wishing to make a paediatric back pain referral to the Physiotherapy service (e.g. GPs, other physiotherapists, consultants) This guideline includes information for physiotherapists who have received a referral for a child with back pain. 2. Scope 2.1 The Paediatric Orthopaedic Physiotherapy service has devised a local referral pathway to guide the referral of patients to the most appropriate health professional. 3. Definitions / Glossary 3.1 Paediatric orthopaedics refers to children aged 0-18 years presenting with orthopaedic conditions. 3.2 Paediatric back pain refers to children aged 0-18 years presenting with back pain. 3.3 Paediatric spinal pain- refers to children aged 0-18 years presenting with back pain. 4. Ownership and Responsibilities 4.1. Role of the Service Lead The service lead is responsible for informing the referrers of the correct referral pathway. Referrals will be monitored and compared with this policy and supporting guidance i.e. accepting appropriate referrals and rejecting inappropriate referrals. Giving feedback on inappropriate referrals Teaching referrers how to exclude red flags and ensure appropriate referrals 4.2. Role of the Physiotherapy Staff All Physiotherapy staff are responsible for: Ensuring the patients are seen by the most appropriate health professional Role of Individuals referring patients into the service All referrers are responsible for: Excluding the presence of red flags prior to physiotherapy referral. In the presence of red flags follow the referral guidelines. Page 3 of 12

4 5. Standards and Practice 5.1 The presence of back pain in those under the age of 20 is a red flag 1 as there is an increased likelihood of more serious pathology in this age group. However, as there are more specific paediatric red flags relating to spinal pain2, the Paediatric Orthopaedic Physiotherapy service has devised a referral pathway to guide the referral of patients to the most appropriate health professional. All Red Flags should be referred to Acute Consultant Paediatrician Team, Child Health, 4th Floor Tower Block RCH Treliske History Pre-pubertal children especially <5 years Functional disability Duration >4 weeks Recurrent or worsening pain Early morning stiffness and/or gelling Night pain Fever, weight loss, malaise Postural changes: kyphosis or scoliosis Examination Fever, tachycardia Weight loss, bruising lymphadenopathy or abdominal mass Altered spine shape or mobility Vertebral or intervertebral tenderness Limp or altered gait Neurologic symptoms Bladder or bowel dysfunction Limp or altered gait 5.2 Children with back pain but the absence of any of the above paediatric specific red flags should be referred as follows: Age over 11 and above Refer to local outpatient musculoskeletal physiotherapy department (Table 1) Age 10 years and under Refer to Paediatric Orthopaedic Physiotherapy Service, Therapy Dept, PAW Building, RCH (Table 2) Page 4 of 12

5 Table 1 - Physiotherapists who have received a referral for a child with back pain should use the following pathway to ensure the child is seen by the most appropriate health professional Page 5 of 12

6 Table 2 - For referrals to the RCHT Paediatric Orthopaedic Physiotherapy Service, the following pathway will be used to ensure the child is seen by the most appropriate health professional Page 6 of 12

7 6. Dissemination and Implementation The document is on the RMS website which GPs have access to and through this will be notified that the document has been up-dated. The document is also available on the RCHT intranet and replaces the previous version. Consultant, GP and Health visitor and physiotherapist training days will be given as part of the update in paediatric orthopaedic physiotherapy training. 7. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Appropriateness of paediatric back pain referrals received by the physiotherapy service Clinical Leads, Paediatric Orthopaedic Physiotherapy Service Compare each referral received by the Paediatric Orthopaedic Physiotherapy Service (POPS) against this guidance; feedback from MSK departments within RCHT and PCH-CIC regarding appropriateness of referrals Each referral received will be monitored by POPS. Feedback will be sought annually from the MSK departments. Proforma response to be sent to referrer detailing reasons for return of referral. Therapy Manager (Outpatients) RCHT or Musculoskeletal Lead for Therapies PCH-CIC to address persistent non-conformance (if identified) for with the appropriate line managers. Required changes to practice will be identified and actioned within one month. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders 8. Updating and Review 8.1. This document will be reviewed every three years by the service lead(s) Revisions may be made ahead of the review date when the procedural document requires updating due to operational / process changes Any revision activity is recorded in the Version Control Table. 9. Equality and Diversity 9.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 7 of 12

8 Appendix 1. Governance Information Document Title Date Issued/Approved: 21 April 2015 Guideline for the referral of Paediatric Back Pain to the Physiotherapy Service Date Valid From: 1 May 2015 Date Valid To: 1 May 2018 Directorate / Department responsible (author/owner): CSSC Division, AHP Therapies (Physiotherapy) Michelle Jackman, Clinical Lead Physiotherapist Contact details: Brief summary of contents Guidance on the referral of children with back pain to the Physiotherapy Service Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: February 2015 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Page 8 of 12 Paediatric orthopaedics, Paediatric back pain, Paediatric spinal pain RCHT PCH CFT KCCG Executive Director of Nursing, Midwifery & A H Professions Guidelines for the referral of Paediatric Back Pain to the Physiotherapy Service v1.0 AHP Therapies Clinical Governance Forum (Feb 2015) Paediatric Orthopaedics Consultants at Plymouth Hospitals NHS Trust (Derriford) (Oct 2014) Consultant Paediatricians RCHT (Oct 2014) Spinal Orthopaedic Surgeon, Peninsula Spinal Unit (Oct 2014) CSSC Governance DMB (April 2015) Sally Rowe, Divisional Director CSSC Janet Gardner, Governance Lead CSSC {Original Copy Signed} Publication Location Internet & Intranet Intranet Only

9 Document Library Folder/Sub Folder Clinical / Therapies / Physiotherapy Links to key external standards Related Documents: Training Need Identified? o Referral guidelines for the Paediatric Orthopaedic Physiotherapy Service o Report of Clinical Standards Advisory Group (CSAG) Committee on Back Pain (1994) o See also Reference List at Appendix 3 No Version Control Table Date 06 Dec Feb 2015 Version No Summary of Changes V1.0 Initial Issue (guideline) V2.0 Mandatory review and update using current Trust policy format Changes to flow diagrams regarding where patients are referred onto to reflect changes in the care pathway Changes Made by (Name and Job Title) Sarah Harvey, Clinical Lead Physiotherapist Rachel Hancock, Clinical Lead Physiotherapist Rachel Hancock & Michelle Jackman Clinical Lead Physiotherapists Carrie Biddle Therapies Clinical Governance Lead All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 9 of 12

10 Appendix 2. Initial Equality Impact Assessment Form Name of service, strategy, guideline, policy or project (hereafter referred to as policy) to be assessed: Guideline for the referral of Paediatric Back Pain to the Physiotherapy Service Directorate and service area: Is this a new or existing Procedure? Clinical Support Services and Cancer Division Existing AHP Therapies, Physiotherapy Name of individual completing assessment: Michelle Jackman Telephone: Procedure Aim* Minimise inappropriate paediatric back pain referrals to the Physiotherapy Service 2. Procedure Objectives* Ensure patients are seen by the most appropriate clinical service 3. Procedure intended Reduced incidence of inappropriate referrals Outcomes* 4. How will you measure the outcome? 5. Who is intended to benefit from the Procedure? 6a. Is consultation required with the workforce, equality groups etc. around this procedure? Analysis of referrals received Paediatric patients No b. If yes, have these groups been consulted? c. Please list any groups who have been consulted about this procedure. 7. The Impact Please complete the following table using ticks. You should refer to the EIA guidance notes for areas of possible impact and also the Glossary if needed. Where you think that the policy could have a positive impact on any of the equality group(s) like promoting equality and equal opportunities or improving relations within equality groups, tick the Positive impact box. Page 10 of 12

11 Where you think that the policy could have a negative impact on any of the equality group(s) i.e. it could disadvantage them, tick the Negative impact box. Where you think that the policy has no impact on any of the equality group(s) listed below i.e. it has no effect currently on equality groups, tick the No impact box. Equality Positive Negative No Reasons for decision Group Impact Impact Impact Age Improved care for paediatric patients Disability Faith and Belief Gender Race Sexual Orientation You will need to continue to a full Equality Impact Assessment if the following have been highlighted: A negative impact and No consultation (this excludes any policies which have been identified as not requiring consultation). 8. If there is no evidence that the policy promotes equality, equal opportunities or improved relations - could it be adapted so that it does? How? Full statement of commitment to policy of equal opportunities is included in the guideline Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 11 of 12

12 Appendix 3. Reference List 1 David J (2007) Evaluation of back pain in children, Paediatrics and Child Health, Vol 18:2, pp Davis PJC, Williams HJ (2008) The investigation and management of back pain in children, Arch Dis Child Educ Pract Ed, vol 93, pp Page 12 of 12