Clara’s story – transitioning paediatric care

Clara’s* background

Clara was born with Global Development Delay and Hypermobility. At the age of six, she was involved in a tragic road traffic accident which resulted in life-changing injuries to her spinal cord. As a consequence, she is now left tetraplegic and ventilator dependent via a tracheostomy tube. The accident also left Clara with Autonomic Dysreflexia meaning she requires regular intermittent catheterisation and bowel care management.

An interim care package

Following the accident, Clara was hospitalised for over six months and was unable to be discharged until the right home care package was in place, one that was proving extremely difficult to find amongst other care providers. Thornbury Community Services (TCS) was the only provider that could promise a solution to meet the complexity of the package requirements and requested timelines. TCS were approached by the CCG to provide interim care before handing Clara’s treatment over to a Community NHS team on a long-term basis. From assessment to discharge, our team worked around the clock, with the utmost efficiency to get Clara safely back in her own home. Once Clara was discharged, our experienced team of nurses and support workers provided consistent continuity of care over a 10-week period, covering 100% of a total of 70 shifts. By having such a robust team present during the night, Clara’s parents were able to be fully rested and recuperated to provide care throughout the day so the family could enjoy quality time together.

Transparency and excellent communication

We maintained an honest and open relationship with Clara’s parents throughout the transition which played an integral part to its success. Expectations were made clear right from the outset and the family were fully aware of the role TCS were playing and the plan for us to step back. Understandably, there was a high level of anxiety from both Clara and her family about moving from the hospital ward back home. To help put the family’s mind at ease, we met with Clara’s parents at the initial assessment stage to gain clarity of their expectations and address any worries they had. Clear and effective communication was also upheld with the hospital and NHS community complex team making the process seamless. The NHS nurses shadowed our team of nurses to ensure they had the confidence and familiarity to effectively deliver Clara’s care plan independently.

The outcome

TCS provided an interim solution where no other care provider could. As a result, Clara is now back in the comfort of her own home, in much safer and more suitable surroundings compared to those of the hospital ward. Our nursing team received extremely positive feedback from the CCG, Clara’s family and the community nursing team following the transition. 

*Name has been changed for data protection