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Kayleigh is 5 years old and was diagnosed with oligoarticular JIA 12 months ago. She had joint injections under general anaesthetic with a good result and eye screening showed no signs of uveitis. She lives with her dad and sister as mum left the family home several years ago after a long history of substance abuse. A social worker was involved in supporting dad at the time but the case has since been closed.

Unfortunately Kayleigh develops further swollen joints over the next 6 months and the decision is made to start subcutaneous methotrexate (MTX). The community children's nurses (CCNs) provide support in assisting dad to administer her injections. After 6 weeks the CCNs report that dad is managing to give Kayleigh her injections and they discharge her from their caseload.

The clinical nurse specialist (CNS) is advised that Kayleigh has failed to attend 2 of her eye screening appointments with the ophthalmologist. She then fails to attend an appointment with the rheumatology team. The CNS manages to contact dad on the telephone and he sounds sleepy and apologises - explaining that the family have all been unwell and he forgot about her appointments. Another appointment is made but she fails to attend. Kayleigh has not been reviewed for over 5 months and her blood monitoring is also overdue. The home care company call the CNS to explain that they have struggled to contact dad and been unable to deliver her medication for several months.

The CNS manages to contact dad again - he explains that he has had a 'bad back' and will bring her to clinic. The CNS arranges to have her eyes screened at the same visit. Kayleigh arrives with her dad whose speech appears slurred and he seems restless. A friend has driven them to the hospital. At the end of the rheumatology review, dad wishes to leave explaining he has a bad back and is taking tramadol. The CNS is concerned that she needs to attend her eye screening appointment and offers to take her to the ophthalmology department. Kayleigh is diagnosed with active uveitis in both eyes and commenced on predsol eye drops.

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