Comparison of Wye Valley Trust motor neurone disease (MND) integrated care pathway with current NICE guidelines and monitoring of domiciliary non-invasive ventilation (NIV) via wireless modem

Abstract

The National Institute for Health and Care Excellence (NICE) published clinical guidance for managing NIV in MND. Aims: One-year evaluation of an integrated ventilation care pathway for MND. Methods: An integrated respiratory pathway was established in January 2015 to provide domiciliary NIV for patients with MND in Herefordshire Results: Between January 2015 and January 2016 nine patients with MND were assessed and initiated on domiciliary NIV and monitored via a wireless modem. Four patients died and four remain on treatment. One patient declined ventilation. Patient deterioration was accurately identified by the way of the remotely monitored tidal volumes and ventilation data. This facilitated timely palliative care intervention for all 4 of the patients who died. (Three patients died in the hospice and 1 at home.) None of the remotely monitored domiciliary ventilated patients were admitted to the acute hospital. Respiratory tract infections (2), mucus plugging (2) and secretion management difficulties (1) were successfully identified by analysing tidal volumes and compliance data to allow intervention and prevent hospitalisation. Conclusion: An integrated ventilation clinic and pathway facilitates accurate,comprehensive and tailored assessment with precise real time monitoring of patients requiring domically ventilation.