Role of Multidisciplinary Team in Delivering Care to Walter

This assignment focuses on the identification of members of the multidisciplinary team involved in delivering care to Walter, their roles, and the facilitators and barriers that may influence collaboration between Walter and the MDT. It also discusses the role of the community nurse in the Health Care Home Program and the benefits of the services provided to Walter.

CASE STUDY

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY..................................................................................................................................1
1. Identification of members of multidisciplinary team (MDT) involved in delivering care to
Walter, with their roles as part of an MDT approach..................................................................1
2. Identification and description of facilitators and barriers that may influence collaboration
between Walter and the MDT working on providing care to patients with chronic health
conditions.....................................................................................................................................2
3. Description of role of the community nurse working in Australia involved in the care of
Walter and the Health Care Home Program................................................................................3
4. Discussion of benefits of the following services for Walter provided as being part of Health
Care Home Program....................................................................................................................4
CONCLUSION................................................................................................................................6
REREFENCES................................................................................................................................7

INTRODUCTION
Healthcare homes are kind of healthcare services that are provided to patients at their
homes by a group of individuals working in health and social care organizations. They provide
various kinds of required healthcare services to patients at their home for management of
diseases or health issues suffered by them. This assignment will focus upon analysis of a case
study of patient named Walter who is suffering from m type 2 diabetes, chronic kidney disease
and moderate depression.
MAIN BODY
1. Identification of members of multidisciplinary team (MDT) involved in delivering care to
Walter, with their roles as part of an MDT approach
Multidisciplinary teams are group of individuals working health and social care
organizations who are members of different disciplines so that they can provide specific service
to patient (Tan & et. al., 2020). There are various number of members involved in
multidisciplinary for delivering high quality of care to Walter. Each of them had their own roles
and responsibilities. Main members of multidisciplinary team identified are:
 GP: GP will be examining medical history of Walter, conduct clinical examination so that his
condition can be checked in a proper and accurate manner (Grol & et. al., 2018). GP will also
focus upon providing and updating drug chart from time to time depending upon health
condition of patient (Whyte & Munro, 2019). They will also provide and update patient with
information about his health, medicines prescribed to him.
 Nurse: nurse will be checking vital signs of Walter and develop a report for the same and
provide it to GP. Nurse will also focus upon checking whether all the nutrition, hydration,
medicines are being provided to Walter on time or not (Bonvento & et. al., 2017). Nurse will
continuously monitor condition of Walter at least once in a day so that chances of infection
can be reduced.
 Pharmacist: Pharmacist will be providing all the medicines prescribed by general practitioner
and psychologist (Wang & et. al., 2016). Their main role will be to review all the medicines
prescribed to Walter, review his drug chart regularly.
 Nutritionist: Nutritionist will be focusing upon developing a diet plan for Walter as per this
current medical condition after consulting or having a discussion with other members so that
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improvement within his health can be brought and effectively of treatment and medicines can
be increased (Schiavo & et. al., 2019).
 Psychologist: Psychologist will be providing special talking therapy to Walter so that they
can provide appropriate and required treatment to him and bring improvement within his
depression condition (Lunn, Restrick & Stern, M., 2017). They will also perform in-depth
assessment so that they can understand reason because of which patient was suffering from
moderate depression (Collister & et. al., 2019).
2. Identification and description of facilitators and barriers that may influence collaboration
between Walter and the MDT working on providing care to patients with chronic health
conditions
There are various kinds of facilitators and barriers that can directly influence
collaborative working between Walter and MDT working upon providing him with required and
accurate service and care. Barriers that can influence collaborative working between MDT team
and Walter can be explained with the help of two main levels of barriers that are: micro and
meso level barriers.
Micro level barriers: Skills and abilities of staff members is one of the main micro level
barriers that can influence collaborative working between Walter and MDT team (Rosell & et.
al., 2018). If team members of MDT team are not skilled and do not have required abilities then
it can directly influence quality of care provided to Walter (Lash-Marshall & et. al., 2017). Not
only this, it will impact the effectively of treatment provided to him and confidence level that
Walter has upon his MDT team will also get impacted. Confidence level of MDT team members
is another barrier in collaboration and can influence quality of care and treatment provided
(Owens & et. al., 2017). Overconfident team members do not think of taking advice from other
team members and can continue their working whereas, under-confident team members will not
be able to take any tough decision in terms of health condition of Walter (Murphy, Curtis &
McCloughen, 2019). In both the cases trust and confidence level of Walter in this MDT team
will get disturbed due to which effectively of treatment provided to him will get impacted
especially treatment and therapies provided to him for his moderate level depression.
Meso level barriers: training is one of the main Meso level facilitator or barrier that can
impact collaboration between Walter and MDT team (Tschudy & et. al., 2016). Provision of
proper and time to time training to team members of MDT team can help in increasing
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effectiveness and quality of treatment and care provided to Walter (Morano & Damiani, 2019).
This can also help in strengthening collaboration between patient and MDT team (Dellafiore &
et. al., 2019). But if there is lack of training then it can work as a barrier in effective
collaboration. Not only this, lack of training will directly impact quality of care provided to
Walter. Other than this, health service policy can also work as a barrier in provision of high
quality of service and care to Work. It is important to focus upon this barrier because if can
negatively impact collaboration between both Patient and MDT team (Theys, 2020).
3. Description of role of the community nurse working in Australia involved in the care of
Walter and the Health Care Home Program
Healthcare home is a supportive service which is provided to patients by professional
health and social care givers in patient’s home. There are various kinds of programs that are
offered by healthcare homes. These programs are designed in such a manner that a healthcare
team can be provided to people with chronic health conditions so that their healthcare condition
can be managed (Currie, Chiarella & Buckley, 2018). These kinds of programs are important to
be developed because in Australia one in four individuals suffers from some serious chronic
conditions like diabetes, cancer, heart diseases etc. (Taylor, Cairns & Glass, 2020). When people
suffer from more than one chronic condition then in such case, they need to see different doctors
and need to coordinate with them which can become a bit difficult for them to do so (Nazarko,
2019). Especially for aboriginal people it is more difficult to coordinate with healthcare
providers. So for this, healthcare home programs are developed. Main aims of these programs
are: set health goals, help in management of chronic health condition of patients and identify best
possible ways to manage their needs.
There are various kinds of community nurses involved in these healthcare home
programs and their main role is to provide excellent services to patients. Their primary role is to
provide excellent and high quality treatment to patients (Sangkala & Gerdtz, 2018). Role of
community nurses in Australia who are involved in care of Walter and health care program has
different kinds of roles and responsibilities such as: Community nurse will provide training and
education to Walter so that he can understand maintain his health and decrease seriousness of
chronic diseases from which he is suffering (Keleher & et. al., 2017). Community nurse is also
responsible for conducting health screening so that they can measure improvement within their
health condition. They also focus upon bringing improvement within nutritional values of Walter
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by bringing improvement within his diet. This will help in bringing improvement within his
type- 2 diabetes and chronic kidney disease condition. Community nurses can collaborate with
healthcare home program tam and can work in monitoring diabetes level, kidney disease problem
(Roberts & Blanchfield, 2020). They can also focus upon assisting GP or other specialist in
examination of medical procedures. They can also give required injections to Walter like insulin
injection etc. Community nurses will continuously maintain communication and coordinate with
other team members of heath care home programs so that quality of care provided to Walter is
not compromised (Dykes & Stewart, 2020).
4. Discussion of benefits of the following services for Walter provided as being part of Health
Care Home Program
4.1. Symptom plan
It is a kind of plan which is developed by healthcare practitioners of healthcare home
programs. This plan helps the healthcare home program team to understand chronic health
condition that has been diagnosed (Faiman & et. al., 2017). With the help of this plan all the
symptoms identified and are being seen within patients so that current symptom plan for
managing those symptoms can be developed. This plan also consist of a section that helps in
identifying what can happen if those symptoms are not managed. This plan helps in development
of an effective management plan though which serious chronic condition of patients can be
managed. Some of the main benefits of Symptom plan are: it helps in identifying main symptoms
that are required to be managed and if not managed then those symptoms can increase
seriousness of the disease. There are different kinds of Healthcare home programs for different
chronic diseases. Management of each of these diseases is important to be done so that
effectiveness of the program can be increased. And serious or chronic condition of the patient
can be managed in a more appropriate and effective manner.
4.2. Patient-centred care coordination and enhanced access
Patient centred care coordination (PCCC) is an important service that majorly focuses
upon fulfilment of patient’s healthcare needs. PCCC focuses upon development of coordination
between patient, healthcare home program team and patient’s family so that main goals of PCCC
can be accomplished. It further helps in bringing improvement within clinical outcomes, medical
cost and overall satisfaction of patient (Leeson & et. al., 2018). Some of the main benefits of this
patient centred care coordination service are: it helps in enhancement of outcomes of medical
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treatment provided to patients though different kinds of methods such as telehealth, self-
management support, engagement of health information technology, transition of care
management of chronic healthcare conditions, maintaining coordination among healthcare
providers and healthcare system (Wilson, Waddell & Lavis, 2016). Another benefit of PCCC
service is that it helps in increasing success changes of healthcare home programs. It further
helps in enhancement of patient’s health outcomes, increases compliances with CMS regulations
so that overall needs of patient and their family members is meet.
Whereas, enhanced access is an important fundamental concept of patient centred
healthcare homes for enhancement of care of patient (Fix & et. al., 2018). It also helps in
bringing improvement within healthcare outcomes, reduces healthcare cost and enhances overall
experience of patients. Some of the main benefits of this enhanced access service in healthcare
homes programs are: It helps in ensuring that patients have 24*7 accesses to their care teams
regardless of any kind of advance or digital technology (Baylis & Perks-Baker, 2017). It helps
patients in attaining health insurance coverage. Also helps in provision of scheduling options to
all the patients so that they can schedule their healthcare home visits from professions whenever
they are comfortable with.
4.3. Benefits of including a pharmacist in Walter’s case
There are various kinds of benefits that inclusion of pharmacist in Health Care Home
Program can be provided in case of Walter. Some of the main benefits are: they help in bringing
improvement within safety and quality of patient care (Daniels, 2017). They can also help in
decreasing overall cost and expenditure associated with health care services and medications.
Pharmacist can help in educating patient with effectiveness of all the medicines and treatments
that are being provided to them so that they can further cooperate and focus upon their health
even more (Bryant & et. al., 2017). They also help in maintenance of safety and security of
patients medically by providing support to nurses and clinicians in case of some serious and
complex cases (Alsaleh, 2020). They can also help the patients in explain or educating them
about some serious issues or factors that are required to be focused upon them for proper and
effective management of health condition.
In Walter’s case pharmacist can help Walter in providing information about
effectiveness of all the medicines that are being provided to him for treatment of type 2 diabetes,
kidney disease and ways in which effectiveness of these medicines and treatment can be
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enhanced. They can also monitor medicines taken by him, doses provided to Walter so that
effectiveness of these medicines can be maintained.
CONCLUSION
From the above assignment, there are many healthcare homes in Australia that helps in
provision for required services and care to patients who are suffering from chronic or serious
disease. These healthcare homes involve a multidisciplinary team that focuses upon fulfilling
healthcare needs of patients and also helps in bringing improvement within overall condition of
the patient.
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