Older Adults Division: Home Treatment Team SOP

Transcription

1 Lincolnshire Partnership NHS Foundation Trust (LPFT) Older Adults Division: Home Treatment Team SOP DOCUMENT VERSION CONTROL Document Type and Title: Standard Operating Procedure: Older Adults Home Treatment Team Authorised Document Folder: New or Replacing: Service Operational Protocols New Document Reference: Version No: V1 Date Policy First Written: September 2018 Date Policy First Implemented: October 2018 Date Policy Last Reviewed and Updated: Implementation Date: October 2018 Author: Approving Body: Dawn Parker Quality Assurance Lead Older Adults Divisional management team Approval Date: October 2018 Committee, Group or Individual Monitoring the Document Older Adults Divisional management team (DMT) Review Date: September 2019

2 OA H T Hospital at Home Older Adults Division Standard Operating Procedure Older Adult Home Treatment Team (HTT) October 2018 Dawn Parker Quality Improvement and Assurance Lead Deborah Blant Acute Care Pathway Lead Alan Pattison: Business Manager 1

3 Contents Page 1: Introduction 3 2: Service Description 2.1. HTT Staffing 2.2. Location of Service 2.3: Hours of Operation 3: Referral and Inclusion Criteria 3.1: Inclusion Criteria 3.2: Exclusion Criteria 3.3: Service Threshold 3.4: Service Access 3.5: CMHT Duty Worker triage and support 3.6: Service Capacity 3 6 4: Gatekeeping 11 5: HTT Interfaces and Team Working : Interface 5.2: Team Working 6: Assessment and Treatment 6.1: Assessment Outcomes 6.2: Treatment 6.3: Medication 6.4: Deteriorating Mental Health 6.5: Early Discharge 6.6: Exit from HTT 12 7: Carer Support and Involvement 16 8: Patient and Carer Feedback 16 9: Team Safety 9.1: Safeguarding 9.2: Supervision Appendices 17 Appendix 1: Physical Health Care Appendix 2: HTT Core Assessment Appendix 3: HTT Service Pathway 2

4 1: Introduction The provision of Home Treatment (HT) reduces the frequency and length of hospital admissions for people experiencing an acute episode of mental illness. The team will have a recovery focus in their work with patients and carers, seeing each patient as an integral part of a family, community and work as part of neighbourhood team (NT). Within the Home Treatment Team (HTT) model people using the service are viewed as part of a network, with support to and collaboration with carers being the core role of the HT service. The person remains in contact with their own resources and support networks, allowing treatment to utilise the individual s strengths. Family and carers can be actively involved in all aspects of care with the patient s consent. Care is provided in the least restrictive environment, with the minimum disruption to their lives to meet the person s clinical and safety needs, providing credible alternatives to hospital admission. Community teams are essential in continuing to support home treatment and their role of care coordination 2: Service Description The HTT will review people who are clinically escalating towards consideration for acute admission and/or on a discharge trajectory whilst in acute care and consider if they can provide a less restrictive alternative. The aim of the HTT is to; Provide intensive home based support and treatment. Facilitate discharge from in-patient care at the earliest opportunity for each patient. Support patients to remain at home or return home after a shorter admission and receive the treatment they need to start recovery from an acute episode of mental ill health. The HTT pathway is set fully out in Appendix : The HHT staffing: The HTT is a multidisciplinary team comprised of; 3

5 Service Manager - Band 8a Clinical Team Leader Band 7 Admission Discharge and Liaison Role Band 7 Consultant Psychiatrist (0.5) Deputy Clinical Team Lead (1) Band 6 Senior Acute Care Practitioner Band 6 Acute Care Practitioner/ Occupational Therapist Band 5 Healthcare Support Workers - Band 3 Team Administrator (1) 2.2: Model of Care: named workers As set out in the HTT pathway (Appendix 3) the HTT model provides an interim supplementary model to existing CMHT-based care-coordination of intense support and intervention (up to x3 daily face-to-face visits plus telephone support) over the 7-day week; for a time-limited period (avg. 6 weeks). CMHT care-coordination remains in place throughout the period of HTT intervention to ensure continuity of care and smooth transitions of care at both service access and exit thresholds. The model will also facilitate access to and use of none-acute care settings to supplement a stepped pathway of service offers. These will include access to and use of the Psychiatric Clinical Assessment Unit (PCDU) for unit based short-term assessment and Crisis Houses for step-up, step-down sub-acute support. The HTT will stay actively engaged in assessment and support across and within all care settings in used for patients accepted into the service. The HTT implements a Consultant-led service with a named worker system. This is used to support home treatment in delivering consistent care and making every contact count. The patient on acceptance to the HTT service will be deemed to meet the threshold for the Care Programme Approach (CPA) (section 3.3). When under the care of the HTT each patient will be allocated a 1st and 2nd named worker with Consultant review via bi-weekly MDM/CPA review (section 2.3) and individual patient review daily as required. The named workers have responsibility for the majority of a patient s contact with HT and for jointly planning the patient s care with the patient, carer and others (e.g. CMHT) involved services. 4

6 2.3: MDT Review: Meetings HTT will meet daily with a handover meeting held each day. Any actions agreed in handover will be documented on RiO for the relevant service user. The HTT will have dedicated SBAR board for tracking patient journey and support allocating handover tasks. HTT will meet at least weekly for a Multi-disciplinary Clinical team meeting chaired by the Consultant Psychiatrist (or delegated representative). Any actions agreed in the MDT will be documented on the clinical system (RiO) of the relevant service user. MDT quorum will comprise of Consultant or delegated deputy; pharmacy or delegated deputy; Occupational Therapist; HTT staff and CMHT members where required dependant on stage in patient journey. The clinical lead for the team (band 6 or above) will book patients into the MDT review to ensure that patients are reviewed at key points of the service pathway (see > Appendix 3) for the 72hr; 2 week; 4 week and 6 week review or for the Care Programme Approach meetings. 2.4: Location of HTT service delivery: The HTT will be based at Witham Court, Lincoln and with links to OA-CMHT team duty workers will provide countywide access and service delivery. Patients will be seen in a wide range of available environments / locations, according to each patient s identified recovery needs and safety considerations. This includes: At home At the home of patients family and friends Inpatient ward In a range of community venues (according to the needs of the patient) 2.5: Hours of Operation The HTT will operate the following hours: Monday to Friday (including bank holidays) the service will run 8am to 8pm. 5

7 Weekends and public holidays the service will run a 10-6pm service 2.6: Response times The time between referral to the HTT and initial contact with the patient will be no more than 12 hours. The timely response for each referral will be discussed at the point of referral with the referrer. It is most likely to be determined by risk factors. Any cases not seen within this time frame should have clearly documented clinical rationale. Outside of HTT operational hour s crisis support for people who are under the care of home treatment and their carers can be requested via LPFT SPA who will triage the urgency and response requirements. 2.7: Telephone calls HTT staff are mostly out of the office (carrying out their clinical work with patients). Phone calls will be answered by administrative staff during their core working hours. An HTT answering machine and call divert facility will be utilised where appropriate. (Contact details for the service are , option 2). The answering machine will also provide contact details for LPFT Single Point of Access (SPA) in case of emergencies. Clinical Staff endeavour to respond to all messages within 1 ½ hours. Patients and family and carers are to be made aware of response times when they first meet Home Treatment staff. 3: Referral, inclusion criteria 3.1: Inclusion criteria: This guidance is to assist the referrer. All referrals will be discussed on individual presentation: People aged 65 years + with complex mental illness related needs WHO are on the threshold of psychiatric hospital admission due to an acute episode of mental illness AND 6

8 who fall within one or more of the following presentations: Severe and persistent mental disorders associated with significant disability. Such as, schizophrenia, bipolar (manic depressive) disorder and severe depression. People whose presentation requires intense assessment and diagnosis to provide clarity of their mental health needs. Longer term disorders of lesser severity, but characterised by poor treatment adherence requiring proactive follow up. Mental health problems where there is a significant risk of self-harm or harm to others (e.g. acute depression) or where the level of support required is beyond what the community based mental health teams set up to provide but not of a risk level requiring 24hr observation. Medication initiation in the community as an alternative to initiation as an inpatient. People with severe disorders of personality that require short term input to assist them to manage aspects of their condition People who have a dual diagnosis (e.g. Mental illness with Learning Disability, alcohol or substance misuse) will not be excluded. Patients with mental illness secondary to physical, dementia or other neurological conditions, who do not have acute medical issues may be suitable for HTT. The decision to start home treatment should not depends solely on the diagnosis, but consider inclusion criteria within the broader context of the following aspects; Severity and complexity of the presenting needs and problems Level of distress Vulnerability of the patient and any issues of safety and support at home Person's cooperation with treatment. 3.2 Exclusion Criteria: In order to provide a service to those who are at greatest risk of requiring a psychiatric hospital admission, the HTT are less likely to offer a service for the following conditions: Mild or Moderate anxiety disorders Primary diagnosis of alcohol/substance misuse Primary diagnosis of a learning disability 7

9 Recent history of self-harm, but not suffering from a mental disorder Primary need related to experiencing dementia (i.e. Organic illness) A crisis related solely to relationship issues/or other social issues NB: Home Treatment teams are not able cover the leave of a patient s community mental health team worker. HTT may not accept referrals where there is no indication that HTT input will have therapeutic value. 3.3: Service Threshold: The threshold for HTT access based on inclusion criteria (section 3.1) include; People who would need admission to an acute psychiatric inpatient bed if Home Treatment was not available to them but whose needs do not require 24hr observation and care. People who have been in hospital, whose needs are now at a threshold, no longer require 24hr support, that they can safely be managed in the community with Home Treatment Support. The person being referred is in receipt of Care Programme Approach (CPA) level care. Individuals experiencing dementia associated needs may sometimes be suitable for Home Treatment if the acute medical issues have resolved e.g. patients with head injury/epilepsy etc. who have mental health problems due to a chronic organic cause Service Access. The primary pathway for access to the OA-Home Treatment Team is via escalation within the OA-CMHT s. However, access may also occur outside of this primary pathway by other teams providing they have had a face to face assessment, meet the service inclusion criteria (section 3.1) and threshold (section 3.3): without HTT intervention admission is likely: Community based mental health teams Inpatient mental health teams The Assessment Team and the Mental Health liaison service Crisis Resolution and Home Treatment (CRHT) team* 8

10 136/AMHP service* *The HTT is not a crisis service. The LPFT CRT is commissioned to support Crisis Response to adults of all ages with functional mental health crisis needs for assessment. The HTT will only support associated HT needs where admission has been indicated. The team is not the crisis assessment of cases occurring via these routes. Services other than the mental health teams (e.g. Primary care, acute hospitals, and drug and alcohol services) cannot refer directly to HTT. Self-referrals to HT are not accepted; however wherever possible HT staff will advise people how they can access services. Referrals can only be accepted following a discussion between the referrer and Home Treatment team. Written records must also be provided (i.e. mental health assessment and care plan, risk. It is the responsibility of the referrer to ensure that patients and carers are aware of the referral. 3.5: CMHT Duty Worker triage and support. As part of the HTT hub and spoke service model OA-CMHT county wide teams will utilise allocated duty workers to support HTT access triaging. The core role and responsibilities of the CMHT duty workers include: OA-CMHT duty worker will screen and communicate any escalating OA-community cases (current on the books or unknown cases) where admission is considered as an option. All referrals will have been seen face to face, have a full clinical risk assessment in place and the duty worker must deem that the level of presenting risk exceeds that of what is manageable in a community setting. There will be a clinical conversation between the duty worker and the HTT in regards to the risk and what interventions the HTT could provide. If the presenting risk is deemed too high for the remit of the HTT then admission will be sought as per pathway. 9

11 If the presenting risk is deemed to be acceptable for management in the community the HTT will turn down the referral (there will be a period of joint monitoring and negotiation between CMHT and HTT in the early stages). The OA-CMHT will continue with their in-put alongside the HTT involvement. OA-CMHT will attend/conference call for key reviews at 72hrs and pre-discharge CPA within HTT pathway (see appendix 2) 3.6: Service Capacity It is essential that the HTT service has capacity to retain flexibility around visiting. Duration, frequency and intensity of visiting will be a key requirement to successfully deliver an alternative to hospital admission. To support provision of a flexible and safe Home treatment service the guide caseload capacity for a team of the equivalent of 21 patients. It is likely that each in-patient service based referral open to HTT requires less of the teams time, with the majority of care being provided by the inpatient unit staffing supported by the HTT. Each inpatient referral may therefore be considered as 0.5 on the caseload, rather than 1.0. This figure is also in line with national guidance on capacity of Crisis Resolution/Home Treatment teams : Where a team has no capacity to take on a patient who needs the service the following actions are taken: Review current case load and identify patients who are ready for discharge from HTT with OA-CMHT support Make use of patient aligned resources within OA-CMHTs to support discharge from HTT 10

12 4: Gate keeping All people deemed in escalating need of potential admission to an OA Mental Health acute ward (i.e. excluding dementia/organic mental health wards) will be assessed for suitability to be treated in their own home by the HTT*; prior to any decision to be admitted to hospital. Gate keeping ensures all patients have the opportunity to be assessed for treatment at home/in the least restrictive environment. The assessment will be undertaken by the HTT in liaison with the service(s) requesting the need for admission (section 3.4). *this excludes those assessed under the MHA to require compulsory admission for assessment. 5: HTT Interfaces and Inter-team working 5.1: Interface The short term nature of HT work means that every patient requires HTT named workers to liaise with colleagues in other services, teams and agencies. Day to day issues are discussed and resolved by the staff concerned with the support of their line management. Regular meetings between teams are held to specifically address interface issues. These are held regularly with the following services; Inpatient units Older Adult - Community Mental Health Teams (OA-CMHT s) Mental Health Liaison Service (MHLS)Teams Crisis Resolution and Home Treatment (CRHT) teams The HTT will Interface with other services and agencies, driven by the needs of each patient and his or her circumstances. 5.2: Inter-team working The HTT will also provide support to patients placed within the PCDU (Psychiatric Clinical Decisions Unit, up to 48hrs (Lincoln) and Crisis House s (Boston and Lincoln). This will enable patients to access other admission avoidance services or place of safety whilst awaiting assessment or admission to an acute admission ward locally or out of county. Admission to the Crisis Houses to avert an escalation of social circumstances in particular, is 11

13 available via CRT with agreement that support is provided by HTT for the duration of the placement. 6: Assessment and Treatment. 6.1: Assessment Outcome: If the HTT assessment determines that neither HT nor admission to hospital is required, and the service user is already open to an existing Trust service, that service will continue to be responsible for agreeing and arranging on-going services. The patient will be referred back to the referring service/ source with clear documentation of the clinical reason for doing so. If there is any dispute in relation to this decision, HTT will work jointly with the existing service to ensure there is an interim plan of care for the service user until the dispute is resolved. In all cases of HTT decision that HT and admission are not required, HTT will ensure a risk assessment will be clearly documented and contingency plans considered and agreed with the patient and relevant family or carers. 6.2: Treatment/Interventions: Central to the successful provision of HT is staff s acceptance and understanding that mental health problems occur within the greater context of people s lives and should not be viewed in isolation from this. The purpose and objectives of HTT service engagement are to be agreed with patients, carers and colleagues and clearly documented at the initial contact/assessment. This is considered essential to delivering a recovery focused service. To support admission avoidance/early discharge, HTT treatment/intervention offer could include the following clinical interventions: Comprehensive psycho-social assessment of mental health (as per standardised HTT core assessment format see Appendix 2) and (as indicated) : o advance statements, o WRAP planning. 12

14 Comprehensive assessment of Risk to self, to others, from others, vulnerability, neglect and physical health Explore existing support systems - including family, carers and friends Diagnosis Psychopharmacological treatments in accordance with NICE guidance; These may include medication reconciliations, active medication management and administration, introduction and titrations of new regimes, monitoring, testing (see also section 6.3: medication) Psychological interventions in accordance with NICE guidance; these may involve; o Psycho-education, o CBT; o Activity scheduling, o Problem solving Emotional First Aid/Brief therapy Carer/family psycho-education and support. Carer s assessment where indicated Joint working with partner agencies to ensure access to holistic care and treatment. Make early plans to help patients maintain their day-to-day activities; including work, education, voluntary work, and other occupations such as caring for dependants and leisure activities, wherever possible. And also support access to and interface management of care via; Step-up/step-down Crisis House accommodation Access to and support assessment within PCDU (Psychiatric Clinical Decisions Unit) Consider referral to and involvement of social care to support social care activity to prevent admission Access to OA in-patient facilities in a timely and supported manner. 6.3: Medication The HTT can provide oral and intra -muscular medication as part of their contacts. A plan to support with medication would be agreed with the patient and family as part of the care plan. Where the CMHTs have been undertaking this role it is expected that they will continue to work collaboratively with the HTT and patient 13

15 Wherever possible and safe the patient/family or carer will retain responsibility to keep their own medicine. All medication held by HTT will be stored in a locked medicine cupboard in accordance with the Trust Medication policy. 6.4: Deteriorating Mental Health during a Period of Home Treatment During any period of home treatment further deterioration in mental health could occur and consideration may then need to be given to a period of in-patient care. If this should happen, the HTT doctor or Senior Practitioner (Band 6 and above) must be involved in the assessment of the situation and an up-to-date risk assessment completed. If there is any dispute between professionals over whether or not a service user should be admitted, the matter will be referred to team manager/service Manager and referred to the HTT Consultant or On Call Consultant for a discussion and decision. Should admission for in-patient treatment be required, the Community Consultant will be advised by a member of the HTT and medical responsibility will be transferred to the Inpatient Consultant where applicable. In-patient admission should be arranged with liaison with the teams discharge and liaison practitioner to support access to unit In some situations, a Mental Health Act assessment may be necessary. This will be assessed whenever possible before the end of the working day. The On Call Consultant and Duty AMHP notified accordingly. EDT will only be involved after hours for Mental Health Act assessments when it is not possible to do this involving the HTT Deteriorating Physical Health during a period of Home Treatment Refer to Appendix 1 for further guidance. The presence of comorbid physical and mental ill health will likely be found in the HTT target patient group. It is therefore essential that the monitoring of physical ill health deterioration is taken into account. The HTT will maintain close working relationships with the patients GP and refer/seek further support if you suspect any deterioration. As well as the GP also consider accessing; 14

16 Lincolnshire Community Health Services (LCHS) 111 service*. *Lincolnshire Community Health Services NHS Trust offers urgent medical care outside of normal GP hours, during evenings, weekends and public holidays. These services are accessed by calling 111 to access the NHS 111 services. A range of responses can include CAS (Clinical Assessment Service) they provide a highly responsive and effective network of services across the county for people with urgent but non-life threatening needs. 6.5: Early Discharge from In-patient Care HTT will liaise with the Inpatient Ward daily and attend each ward weekly bed meeting to be actively involved in: Identification of people who would benefit from early discharge/home treatment, The agreement of the predicted date of discharge Support of any anticipated early discharge. A member of the HTT will be present at a ward meeting, ward rounds and reviews to discuss whether early discharge of any service user could be facilitated with a short period of intensive home treatment. All new informal admissions and those admitted on Section 2 without involvement of HTT will have a review within 72hrs by HTT staff to ascertain if early discharge and HTT intervention is a least restrictive alternative 6.6: Exit from Home Treatment Discharge planning commences on admission to Home Treatment and an initial estimated date of discharge (EDD) will be agreed with the referrer patient and HTT. It is usual for Home Treatment input to be gradually reduced (according to patient need) in a stepped approach towards discharge. Home treatment will discharge patients to the care of their originating mental health team. Discharge will be a multi-disciplinary team decision. Discharge planning will be discussed in the HTT multi- disciplinary weekly meetings, daily handovers, and during Care Programme Approach Review meetings at 72hrs; and pre-discharge. 15

17 The OA-CMHT will offer an appointment within 7 days to ensure transfer of care. For new patients to the service (where no previous contact with OA-CMHT has occurred) the followup will be undertaken jointly between the HTT and the OA-CMHT. Family and carers and relevant others must be considered prior to discharge and supported in preparing for exit from the service. On discharge from HTT, PbR, risk assessment and care plan will have been updated by clinicians during the episode of care. Discharge letters or SBARs (Situation, Background, Assessment, and Recommendations) will be copied to the GP, the client should be offered if they wanted a copy, and other statutory agencies will be included. Home Treatment named workers complete discharge summaries within 24hrs of discharge; this includes details of medication to be prescribed and details of on-going care. 7: Carers support and involvement Carers are often integral to a service user s support system and their input and support can substantially improve that person s chances of recovery. The Triangle of Care (2010). The Princess Royal Trust for Carers Although many carers prefer the patient to avoid hospital admission, being in close proximity 24/7 to a person who is unwell, can place carers under considerable strain. Home Treatment teams are mindful of this and work to support and involve carers. 8: Patient and carer feedback Patients and carers are provided with patient outcome measures at the beginning and when identified as ready for discharge from the service F&F questionnaires will be provided on discharge or via telephone to feed back on their experience of HTT. This gives an option for anonymous responses. HT teams ensure patients know how to contact PALS (Patient Advice and Liaison service) should they chose to do so 16

18 Outcome measures: Trust wide measures for HTT pilot are: Number of referrals, Number of open episodes, Response time and the conversion rate between referral. Health of the Nation Outcome Scale (HoNOS) as an outcome measure via PBr Out of Area placements Length of Stay Patient and carer outcome measures 9: Team Safety The safety of HT workers is paramount to the ability to provide an effective service. HT workers frequently work alone in the community and face a variety of challenging situations. The acuity of HT patients conditions and degree of distress they are experiencing can be a particular issue for staff safety. Comprehensive and contemporaneous risk assessment and risk management plans are key in providing Home Treatment. Team members comply with the Lone Worker Policy and Incident Reporting using the Datix System Home Treatment staff are supported by their management to apply a policy for zero tolerance of discrimination, physical or verbal abuse 9.1: Safeguarding If there are either safeguarding concerns of an Adult or Child, the safeguarding team must be contacted for either action or information and a clinical note completed. The safeguarding screening tools must be completed 9.2: Supervision All staff are obliged to receive Supervision and Appraisal as per Trust Policy 17

19 Appendix 1: Physical Health Care Why we have a procedure? Lincolnshire Partnership NHS Foundation Trust is intent that all service users will receive a core review of their physical health needs. All patients admitted to the HTT will receive a Baseline assessment of their Physical Health to support ruling out underlying physical healthcare issues, establish a baseline on which further monitoring can take place and support lifestyle advise and onward referral or signposting. This standard operating procedure (SOP) describes the minimum standard of physical assessments that a service user can expect. The purpose of this SOP is to provide a framework for baseline physical health assessment and safe practice in detecting physiological deterioration of a patient and acting upon any early warning signs, thereby improving patient outcomes and safety. This SOP also aims to provide direction and guidance for the planning and implementation of high quality physical health care interventions for service users within the Home Treatment Team. Underpinning this SOP is the recognition that training and equipment is required at a level which can be effectively utilised by all health care practitioners. What overarching policy the procedure links to? Physical Health Policy Who does the procedure apply to? All staff in the Home Treatment Team When should the procedure be applied? When conducting physical health care of a patient under HTT. How to carry out this procedure Minimum Standard for Physical Examination on Admission to HTT HTT will identify how they will meet the minimum standards described in this SOP and 18

20 address any additional needs of the patient. The minimum assessment and examination standards include: Observation of general appearance Any recent changes in physical health (weight loss/gain) patient s perception Temperature, Blood Pressure, Pulse, Oxygen Saturation levels, Blood Glucose Monitoring and Respirations Base line bloods should have been requested prior to referral to HTT, however it may be necessary for the team to support this for a number of reasons To rule out underlying physical condition To monitor titration of medication Monitor physical health condition In these instances it would be preferable for the team to support the patient accessing their own GP or where this is not possible the team can access inpatient clinics at Boston; Lincoln and Grantham Medical, Nursing and Pharmacy staff have an important role in ensuring that medication reconciliation is completed within 72hrs of admission to the HT. (see Medicines Management Policy) Pharmacy will support reconciliation and play a key part of the weekly MDT to support advice and monitoring It is emphasised that these are minimum standards and in some services a more rigorous examination may be required. Expert advise should be sought from specialist services when specific conditions are already established or identified in the course of the assessment, for example diabetes, coronary heart disease, asthma, chronic obstructive pulmonary disease (COPD), infections and epilepsy. In order to inform care plans, ongoing treatment regimens should be reviewed regularly and documented. Minimum Standards of Equipment Sphygmomanometer digital or manual Stethoscope (if using manual Blood Pressure monitor) Tympanic Thermometer Disposable gloves and Aprons Blood Glucose monitor Pulse oximeter Service Users Refusing Physical Health Care It is not possible to conduct a baseline physical health assessment or care to a patient if they do not consent. Every attempt must be recorded in the patient notes and updated on RiO with the reason why this was not achieved. Staff must make repeated attempts/ offers throughout the patient episode under HTT 19

21 Where a patient lacks capacity to consent to the baseline observations this will be recorded on the physical health observation sheet as well as informing the doctor. Any agreed action must be clearly documented. Physical Health Review The physical health care of the patient under HTT will be considered as part of their initial assessment, documented in the notes. HTT will collaborate with both inpatient and community teams to meet the physical health needs of the patient, MDT will support the patient to access appropriate primary health care services including routine screening programmes, monitoring health promotion as required and support access to community based services Where do I go for further advice or information? Physical healthcare team Patients own GP Practice Neighbourhood teams for complex morbidities Training All staff will have undergone the Philips Training Programme as per competancy matrix. The Trust expectation is that healthcare staff will keep their physical health examination skills and complete self-assessment of medical devices audit yearly. (This will identify any training need for individual staff) The aims of training should be: Understanding the links between serious mental illness and physical health Provision of support and advice to patients in the areas of healthy lifestyles To have an understanding and awareness of the effects of medication on physical health. To be competent in clinical skills all staff are expected to utilise health promotion opportunities and should avail themselves to additional training to Champions and promote those skills in their clinical areas and teams Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Monitoring Compliance and Effectiveness 20

22 What is being monitored Method of Monitoring Monitoring Frequency Person Responsible for performing the monitoring Duties Audit Yearly Registered Nurses Who are Audits reported to Older Adult Matron Equality Impact Assessment Please refer to overarching policy Data Protection Act and Freedom of Information Act Please refer to overarching policy 21

23 OA H T Hospital at Home Appendix 2: OA - HHT Core Assessment Referrer: Designation: Team: Phone No: Where was the Patient seen? A&E Home CMHT Police Custody PCDU 136 Other Service User s Personal Details Title: Last name: First name/s: M F D.o.B: Previous names / aliases : Religion: Relationship status: Single / Married / Separated / Divorced / Living with partner / Civil partnership / Widow(er) Diagnosis Codes: Disability code (if appropriate) None Preferred Language: Interpreter required: Y/N Ethnic origin code: Benefit type: Employment status: Hours worked: Permanent address: Type of accommodation Postcode: Telephone number: Mobile number: Address admitted from (if different from above): Next of Kin/Principle Carer: Address Relationship: Relative informed of admission Postcode: Tel No Y N Date and time: GP Name Tel No: Address: Date GP contacted: Date last seen: Family, friends and carer contact details. Name Contact Details Relationship Living in the Information Sharing Key Household? Full Partial None Holder October 2018 V1 22

24 Relationships Strengths (Who offers most support including Power of Attorney/Deputy etc) Is there family history of mental health problems Yes (give details/ No) Does the family have current involvement with mental services? Yes (give details)/ No Professional Involved Name Profession Current level of involvement Contact details Personal Description (In line with AWOL Policy) Date Description Taken: Height: Eye Colour: Glasses Build: Marks: (scars, tattoos etc.) Hair: (Length and colour) Physical Presentations: (stammer, etc.) Voice/Accent: If Absconding risk, any useful contacts / places: Any person known to be at risk if the person absconds? Any other information relevant to AWOL risk: Reason for referral to HTT: Referral Service user s description of events leading up to the referral: (include history of presenting problems, functioning, safety and identification of symptoms exacerbated by crisis. Helpful/unhelpful past interventions in a crisis) October 2018 V1 23

25 Perception of Current Problem Service User Record views of future goals or aspirations: Nearest Relative/ Carer/ Representative Significant Others (inc. professionals) Current Coping Strategies (inc.views of service users and others) Ask about alternative therapies being used. Mental State Examination Presentation during assessment: (objective and subjective observations, levels of distress, co-operation) Speech: General appearance and behaviour: Thoughts/ Perceptions: October 2018 V1 24

26 Mood/affect: Cognitive Function/ Concentration/ Memory: Sleep pattern: Diet & Fluid: Awareness / Insight: Current Activities/ Interests/ Daily Routine How do they spend their time / Any indications of social isolation/ Limited social activities: Current medication: What medication are you currently taking? Medication Dose/route Frequency (Tick/Indicate) OD BD TDS Other (Specify): Side Effects? QDS PRN OD BD TDS Other (Specify): Side Effects? QDS PRN OD BD TDS Other (Specify): Side Effects? October 2018 V1 25

27 QDS PRN OD BD TDS Other (Specify): Side Effects? QDS PRN OD BD TDS Other (Specify): Side Effects? QDS PRN OD BD TDS Other (Specify): Side Effects? QDS PRN Any known drug allergies: Substance use: relates to alcohol and drugs: Yes/No frequency. Smoking Habits Never Smoked Current Smoker Ex-Smoker Does the service user wish to have any help to stop smoking? Yes (refer to smoking cessation) / No Alcohol Intake Consider type of alcohol, frequency, volume and effects Use of Non-prescribed Drugs or Alternative Remedies Baseline Physical Observations Pulse: Temp: BP: Resp rate: Weight: kg Height cm Dietary needs/nutritional screening: BMI: BM: How well have they been drinking recently? October 2018 V1 26

28 Have they unintentionally lost any weight recently? Frailty & Fracture? History Significant past events (including trauma/ history and life events: Forensic history: Patient View of Current Risk RISK ASSESSMENT EDMONTON FRAIL SCALE Family, Carer, Significant Others View of Risk Risk History Events Date: Description of event: Circumstances, consequences. How related to the mental disorder? Actions taken: Is an Area of Current/Relevant Clinical Risk Identified? If there are no Risks, Quantify your Reasons why. Indicate Y/N Specify risk to whom/ what/ historical/ current/ safeguarding? Risk to others Risk to self Risk from others Risk not otherwise specified None Safeguarding risks October 2018 V1 27

29 Referral required to adult safeguarding Any Additional Specialised Risk Assessments Completed/Indicated? Sources of Information (e.g. Patient themselves, Past Records, Other Professionals etc.) Risk Formulation Problem The specific risk that is being considered Predisposing Factors The factors that increase vulnerability to develop the risk behaviour Precipitating Factors Factors that trigger the onset or exacerbation of the risk behaviour(s) Perpetuating Factors The factors that maintain the risk and prevent its resolution Protecting Factors The factors that prevent and deterioration in the risk. The can include any interviews in place. Risk Summary Immediate Risk Management Plan Discussed with: Date discussed: Risk Management Plan Indicated Where Recorded: Wellbeing/ Clinical Letter Care Plan Positive behaviour Other (please specific) October 2018 V1 28

30 support plan Impression/Formulation: Presenting risk statement. Outcome of Assessment: Names of professionals completing the assessment: Signature: Print name: Profession: Date/time: Signature: Print name: Profession: Date/time: October 2018 V1 29

31 OA H T Hospital at Home The Home Treatment Team Care Pathway Appendix 3: HTT Service Pathway HTT Key Outcome Measures Improved level of acuity and need within 6 weeks of referral. Safe and effective discharge to Community Mental Health Team Improved patient and carer outcomes as measured by: Friends and Family Test (FFT) Wellbeing assessment (WEMWBS) Mental Health Cluster (PbR/HoNos) Ongoing Review HTT/CMHT input Medical Consult CMHT 72 HRS Location of Care Delivery Treatment & review ends: ready for discharge 6 weeks Presentation Pathway start 72hr Care Treatment Pathway MDT Review Weeks HTT Discharge Pathway End Meets referral criteria Agreed outcomes (CMHT- HTT) On CPA Agree Estimated Date of Discharge (EDD) from HTT Referral accepted. HTT respond within 12 Hours CPA review Risk assessment PHC screen/frailty Capacity assessment Initial care-plan Baseline assessmets Outcome measures Emotional First Aid Depression/suicide Psychosis Anxiety Signposting Liaison > CH/PCDU Consultant review Consultant/HTT/Care-coordinator Review baseline Agree outcomes & treatment pathway/plan Medication review EDD review CPA Review Outcomes met Acuity level suitable for CMHT management. Care-plan completed Risk assessment updated PbR/Clustering reviewed Transferred back to CMHT Post-discharge follow-up: 2 day or 7 day If known patient > CMHT New patient > HTT & CMHT HTT Care Delivery Pathway options: CMHT Community HTT Community Crisis Houses Lincoln and Boston Psychiatric Clinical Decisions Unit (PCDU) - Lincoln In-patient Care - Boston LPFT/OAD/HHTPV1/09/2018/SmR