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Trust project site presentations 2 July 2015

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Title: Trust project site presentations 2 July 2015


1
Trust project site presentations 2 July 2015
2
  • Cambridgeshire Peterborough NHS FT (CPFT)
  • Older people inpatient services
  • Ramesh Subbiah
  • Presented by
  • Safer Care Pathways in Mental Health

3
Project sites
  • Willow ward is an 18-bed purpose built assessment
    ward for people who have an acute mental health
    need who require treatment in hospital.
  • Denbigh ward is an 14 bed purpose build acute
    assessment and treatment unit for people with
    behavioural and psychological disturbance who
    living with dementia.
  • We provide comprehensive mental health assessment
    and intensive treatment in a safe environment.
  • Within a framework of individualised patient care
    by which we identify the needs of each service
    user, through collective commitment from the
    multidisciplinary team.

4
Patient Flow High Level
Care Treatment Decision
Care Treatment
Admission
Assessment
Self Care, Physiotherapy, Dietetics, Pharmacy,
Discharge Planning, Therapeutic Assessment
Investigations e.g. X-rays, CT Scans, DOLS
Assessment
Re-assess Discharge Plan
TTOs, Accommodation, Home Visits, Transfers, OT
Assessment, Relatives, Service User
Input Handover (Willow)
Discharge Planning
Discharge Yes/No
Transport Organised, Carers Aware, Handover
complete
Discharge
5
Admission (First 24 hours)
Admission
Welcome Orientation
Patient Interview
Medical Exam
Carer Interview
Patient Activity
MEDS REC
Tests
OBS.
Nursing Assessment
New Prescription
Risk Screen/Assessment Inc. Falls
Initial Care Plan
1 WK Fluid Food
Assessment
6
Care and Treatment
Planning
Questions Why are we dong this? When
Timeframe Who and What do they do How are will
this be delivered?
WHO Doctor Physio/OT SALT/Dietician Nurse/HCA Ser
vive User/Carer/Family Advocates WHEN Timeframe H
OW Intensity of the Input
Psychological
Delivery Treatment
  • Psychological
  • Anxiety Management (11)
  • Talking Therapies
  • Physical
  • OT Activities of Daily Living
  • Physio Exercise, Mobility

Pharmacological
Physical Interventions
ECT
Review
Observations
Intended Outcome
Discharge Planning
7
Discharge
Discharge Priorities
Health Care Professional
Service User
If not improved Ref. to PDSA
Min- MH State
TTOs
Home Essentials e.g. Bread, Milk
Notes/RIO
Transport
Home Leave
Fax Disch. Info to GP/CMHT
Belongings
Hand over plan date/time
Money
Follow Up
Care Package
e.g. Dentist, Dietitian, Diabetic Clinic
Referrals
Informing Family/Carer
If not improved Ref. to PDSA
Mobility Aids
s117 Meetings
Home Assessment
Housing
8
Chosen patient safety improvement project
  • We have chosen Falls prevention and management as
    the patient safety improvement project.
  • Following the review of the inpatient service
    risk registers and the Datix trends, we decided
    to concentrate more on the falls prevention and
    management

9
Rationale Falls
  • Number falls in the OPMH inpatient services
  • 2013 2014 733
  • Number serious incidents
  • 2013 2014- 13

10
Rationale falls

11
Time of the Falls

12
(No Transcript)
13
Since the project
  • Every person admitted to older adult inpatient
    service to have compulsory falls risk assessment
    and no need to complete falls risk screen.
  • Falls lead to feedback in the team meeting about
    the latest trust wide initiatives and changes.
  • Falls prevention and management e-learning has
    been made mandatory for OPMH inpatient staff.
  • Patients were involved in the pathway mapping
    process
  • Patient input via Patient forum.
  • Easier access to the COSHH cupboard- spill kit

14
Plan
  • More staff trained in frontline staff human
    factors training
  • Analyze the data further identify the
    environmental cause, i.e where the fall took
    place.
  • Install the grab rails in the shower rooms
  • Explore other assistive technology equipment
    support with falls prevention
  • Access to mobility aids over the weekend and bank
    holidays.

15
  • Hertfordshire Partnership NHS Foundation Trust
  • Acute day Treatment Unit(ADTU),
  • Crisis Assessment and Treatment Team (CATT),
    Helen Dudeney and Sarah Biggs
  • Presented by
  • Safer Care Pathways in Mental Health

16
CATT
About the service
  • 24 hour crisis service
  • Crisis solution and Home Treatment
  • Gate keeps admission
  • Facilitates early discharge
  • Works in A E at night
  • Work in to the wards and assessment unit.
  • Works with the Host Family Scheme
  • Runs the Mental Health Helpline
  • MDT
  • Third level

17
ADTU
About the service
  • Alternative to Admission
  • 7 day Acute support and Treatment
  • Offers a therapeutic group programme
  • MDT
  • Facilitates early discharge from Wards
  • Third level

18
About the chosen risk focus
  • Medication issues
  • Communication with family members friends
  • Decision making after assessment no further
    follow up
  • Service user involvement did not always
    understand what was going on
  • All pointed to the transfer between service so
    this became our main focus.

19
About the chosen patient safety improvement
project
  • Care call for people not continuing care in HPFT.
  • Next Step Planning

20
Project progress so far Care Call
  • Plan in place We are 1 month into a 3 month
    pilot
  • Engagement fairly successful need to revisit all
    teams to ensure they understand it.
  • Early successes 40 of people couldnt get hold
    of and 60 appreciated it. Service users and
    carers felt it positive all wanted it in other
    services eg Child and Adolescence mental health
    services (CAMHS)
  • Problem solving Revisit it with all teams may
    misunderstand what it is about. Chinese
    whispers.
  • Barriers Getting the message out, using forms
    properly, collating the data.
  • Measure(s) Evaluation forms (summarise), looked
    at serious incidents post assessment as baseline
    data people seen who did end their lives , not
    sure it will make a difference but people think
    its positive and reassuring.

21
Project progress so far Next step Planning
  • Plan in place Algorithm in place
  • Engagement Service users and carers fully
    engaged need to introduce to the teams
  • Early successes Service users wanted to change
    language and make it recovery orientated/Shared
    document/coproduced
  • Problem solving Repeating work already done in
    paperwork on electronic systems want to work in
    a different way. Really include service user
    have more information so when they leave to next
    step they can tell other professionals what the
    next step is so not waiting for the services all
    the time.
  • Barriers Difficult in engaging all
    professionals dont just want another document
  • Measure(s) We still need to collate at the data
    around transfer and incident s

22
Future plans
  • Looking at care call roll out into other areas
  • Piloting next step planning in ADTU but will be
    good in CATT too
  • Revisit and look at pathway and see if we have
    missed anything
  • Feed into the service review

23
Key learning points from your experience of the
SSA process
  • Vital for it to be collaborative with service
    users and carers to ensure rounded viewpoint and
    thinking, to appreciate lived experience, to
    avoid assumptions.
  • We found we identified same hazards i.e.
    discharge transfer but from different
    perspectives
  • Needed to keep revisiting the pathways and SSA
    documents to keep focused and to ensure all
    thoughts captured/cant solve all the complaints
    and unhappiness in the system .
  • Recovery language and what this means to people
    language can create a risk.
  • If people do not understand what is happening it
    is not good for self esteem and therefore their
    whole recovery.
  • We cant make improvements without service users
    and carers.

24
General learning points about your improvement
work
  • Good base line data
  • Getting everyone on board
  • Keeping momentum
  • look at ways in which project profile can be
    raised with other teams trust wide
  • Having the support of the organisation has been
    vital
  • Be patient with the process felt like we
    werent getting anywhere but can see how it all
    works
  • Keeping the human factor element alive in our
    planning

25
  • North East Partnership University NHS Foundation
    Trust
  • Benita Christie - Operational Services Manager
  • Denise Cracknell - Matron
  • Julie King Ward Manager
  • Angie Butcher Area Chief Nurse

26

About the service
  • Two Wards at Kingwood Centre in Colchester
  • Henneage Ward Functional Older Adults, 16
    beds
  • Bernard Ward - Organic Older Adult ,
    14 beds
  • Recent transformation of Community services
    impact on service
  • Changes in Senior Management resulting in two
    parallel projects

27
About the chosen risk focus
  • Henneage Ward - self harm
  • Changing service user population with increased
    risk profiles
  • Discharge planning and aftercare
  • Staff confidence
  • Bernard Ward - Violence Aggression
  • Personal care interventions
  • Patient patient incidents
  • Leadership and co-ordination of clinical team

28
About the chosen patient safety improvement
project
  • Henneage
  • Increase staffs confidence via training, KUF
    STORM,
  • Review handover process
  • Bernard
  • Review systems for gathering key life story
    information on patients normal routines at the
    point of admission
  • Detailed analysis of incidents to inform areas
    for improvement
  • Review ward communication systems, personal
    development plans for staff focusing on
    leadership

29
Project progress so far
  • Staff engaged in project Human Factors training
  • Patient Safety Champions in place, and trained
  • Dedicated medical leadership one consultant
    working with the teams
  • Care plans for personal care interventions being
    signed off by Matron
  • Detailed analysis of incidents started
  • Virtual dementia tour training 6.7.15
  • New STORM trainers trained w/c 29.6.15

30
Future plans
  • Henneage
  • Role out STORM training
  • Provide KUF (knowledge and understanding
    framework) training internally
  • Develop Trust personality disorder pathway
    incorporating Henneage Ward

31
Future plans cont.
  • Bernard Ward
  • All staff virtual dementia trained
  • Set up staff focus group to review patient
    patient, and patient - staff incidents
  • Review staff competencies and training needs
  • Agree 5 key pieces of information required for
    each new patient on admission re their routine

32
Key learning points from your experience of the
SSA process
  • Helped to focus on what the issues were
  • Broadened thinking about the whole system and
    root causes
  • Whole team could participate which supports
    ownership of the issues identified, and finding
    solutions

33
General learning points about your improvement
work
  • Involves the whole team
  • Promotes reflective practice
  • Support a culture of continuous improvement

34
(No Transcript)
35
  • Norfolk and Suffolk NHS Foundation Trust Dementia
    and Complexity in Later Life - Inpatient wards
  • Presented by Debbie Thompson and Sarah Nichols
  • Safer Care Pathways in Mental Health

36
Julian Hospital
About the service
  • Hammerton Court is the inpatient element of our
    mental health services for service users with
    dementia and complexity in later life (DCLL),
    within Norfolk and Suffolk.
  • Hammerton Court opened in March 2012 for service
    users with continuing health care needs. It is a
    hospital environment purpose built for service
    users with dementia. Service users requiring
    admission for assessment and treatment have been
    accommodated in Hammerton Court since May 2015.
  • Our patients have complex needs which cannot be
    met in a community, nursing or residential
    setting.
  • Beach, Rose and Reed Wards have a philosophy of
    person centred care to facilitate.
  • Discharges from our services can be home with a
    package of care, to residential or nursing care
    facilities.

37
About the chosen risk focus
  • Initially there was a very broad focus on the
    care pathway through our services from initial
    referral through to discharge with a desire to
    improve the patient experience.
  • High incidence of falls and violence and
    aggression relative to other services in the
    Trust - Decision - to focus on the DCLL inpatient
    services.
  • Our overarching aim was to create a safer
    pathway for patients within the DCLL Inpatient
    Services
  • FOCUS Reduction of falls, major contributor to
    patient harm in our service, extensions to length
    of stay
  • FOCUS Reduction of violent incidents, high
    levels reported low levels of significant harm
    but major contributor to patients feeling unsafe
    in our services.
  • How could we prevent the above incidents and
    reduce the level of harm when incidents do occur?

38
About the chosen patient safety improvement
project
  • The Lead for the project is the Deputy Director
    of Nursing.
  • Key individuals identified for implementation of
    the project, stakeholders identified
  • Appointment of a SCP Coordinator to collate data
    and coordinate project
  • Focus to reduce falls / harm from falls and
    reduce incidence of violence and aggression
    decided upon.
  • Meeting Schedule for project
  • Leads for the three wards identified
  • Beach Ward modified the role of one of its Band
    6 nurses to drive the project
  • Safer Care Pathways embedded into Ward Staff
    Meeting Agendas
  • SSAs for the two subjects undertaken

39
Project progress so far
  • SSAs Admission procedure, Boredom, Reactive
    practice, Lack of sense of control/ coordination
    of shift, Environment - poor observation, dead
    ends, long narrow entrance corridor frequent
    incidents.
  • Engagement of staff, LMS, Appraisals, allocation
    of link roles building on interests, constructive
    feedback, clarity of expectations, skills
    development
  • Unexpected admissions development of systems
    to reduce frequency
  • Person centred admission procedure developed by
    staff
  • Increased engagement with relatives carer
    support group
  • Ward Move approved by Trust Board
  • Introduction of SBAR communication
  • Focus on increased level of Therapeutic
    Interventions and patient
  • engagement.

40
Project progress so far
  • Barriers
  • Staffing, vacancies, sickness
  • E Rostering, source of discontent for staff
  • Lorenzo electronic patient records, introduced
    the week of the ward move
  • Ward having to respond at short notice
    transferring / discharging/ admitting patients
    with little notice and little pre admission
    information unpreparedness and frequent poor
    communications with significant others
  • Original ward environment, not suitable for
    people with dementia, hotspots where incidents
    occurred
  • Frequent anxiety and incidents on arrival,
    processes and procedures especially regarding
    personal possessions and clothing.
  • Falls- not been a focus only one change to
    practice

41
Future plans
  • Project group to continue meeting
  • Evaluation of the changes to the Role of Band 6
  • Focus onto Falls
  • Project Coordinator presenting data to project
    group and ward staff, regular feedback
  • Measures for Falls and VA (including within
    first 72hours of admission)
  • to continue and monitor impact of changes.
    Baselines for incidents (VA)
  • in the first 72 hours to be reviewed in August
    2015, then 3monthly thereafter.
  • Human Factors to be cascaded throughout teams by
    those attending training
  • to enable facilitation.
  • Patient Safety training to be cascaded to staff
    by Patient Safety Champions
  • Early 2016.
  • Embed into Hammerton Court as a whole

42
Key learning points from your experience of the
SSA process
  • Process implementation has worked splitting up
    the processes original document completed at
    project team level
  • The project team identified at a higher level
    challenges, areas for development
  • The ward team being able to modify the above and
    work out their own solutions has lead to some
    really creative workarounds
  • Removing the data collection requirements from
    clinicians has ensured that the data has been
    collected!
  • Having an identified link between the project
    team and ward team has maintained the focus
  • Will provide feedback for the staff of how their
    changes to practice have reduced incidents, often
    the data is lost when incidents are prevented

43
General learning points about your improvement
work
  • Within our services the identification of a lead
    on the ward with a remit for implementation of
    SCP has facilitated change at a much increased
    rate
  • Engagement of key staff
  • SSA meetings at project lead level then
    brainstorming the detail at ward level has
    ensured ownership
  • Staff devised workable solutions admission
    procedure
  • Staff want to improve their practice and the
    patient experience
  • Implementation of other major changes throw all
    progress off schedule
  • Demonstrable support from the Trust Board
    validates the efforts of staff
  • Change management is hard work!

44
  • South Essex Partnership NHS FT (SEPT)
  • Declan Jacob
  • Presented by
  • Safer Care Pathways in Mental Health

45
About the service
  • Acute and Crisis Pathway
  • Crisis Resolution and Home Treatment Team (west
    locality)
  • Mental Health Assessment Unit (Basildon MHU)
  • Recent strategic review and redesign of service
    model

46
About the chosen risk focus
  • Points of entry
  • Interface with other parts of the mental health
    system
  • Referrer expectation
  • High case loads
  • Throughput and risk
  • Handover

47
About the chosen patient safety improvement
project
  • Cohort of complex service users
  • Decision to admit
  • Variables and presenting risk
  • User led approach

48
Project progress so far
  • SSA 1 2 complete
  • Difficulties in linking to mainstream
  • Need to underpin and support service teams
  • Revisit assumptions

49
Future plans
  • Revalidation and appraisal
  • Operational focus
  • Quick wins
  • Short/medium term initiative
  • Workshop planned for 20th July 2015
  • Dedicated service user and carer event early
    August.

50
Key learning points from your experience of the
SSA process
  • Good discipline
  • Structured
  • Applicable to operational and clinical processes
  • Transferable

51
General learning points about your improvement
work
  • Harnessing learning from human factors training
  • Making a difference in the workplace
  • Improving efficiency and effectiveness
  • Releasing time to care
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