BOOK OF BEST PRACTICE

Transcription

1 LEARNING TOGETHER WORKING TOGETHER BOOK OF BEST PRACTICE Working together Respect & Dignity Empowerment Quality Care Compassion & Empathy Honesty & Trust

2 Contents Value: Working Together for Patients Development of an Assessment Toolkit for the Use of Assistive Technology with Complex Rehabilitation Patients Facilitating Seamless Transfer of Care into the Community Patient Journey Animation Improving Discharge Management Enhancing Collaborative Working Within and Across Teams Value: Respect and Dignity Developing Person Centred One Page Profiles Patient Forum Mindfulness-based Relaxation Group Value: Empowerment The Use of 'e Diaries' to Facilitate Patients Rehabilitation and Therapy Processes Development, Implementation and Evaluation of My Rehab File Development of My Rehabilitation Folder for Patients and their Families/Carers to Support their Rehabilitation Journey Movement Group Development A Self-Management Programme for Patients Following Traumatic Injury or Illness Lifestyles Group - Joint Occupational Health and Dietician Patient Therapy Sessions Value: Commitment to Quality of Care Upper Limb Management Pathway Patient Equipment Tracking System (PETS) Development of the Upper Limb Management Pathway The Role of the Social Worker to Enhance the Social Care Element of Patient Rehabilitation Introduction of Therapeutic Specialling Implementation of Goal Attainment Scale Constraint Induced Movement Therapy for the Patient with Higher Level Upper Limb Function Urinary Catheter Diary Creating Video Tours to Support People Following Traumatic Injury or Illness for Admission to an Inpatient Rehabilitation Unit Peer Review Programme Vitamin D Status and Its Effect on Functional Outcome Cheshire and Merseyside Rehabilitation Network Educational Programme Improving Knowledge of Mental Health Problems in the Context of Brain Injury. Improving Knowledge of the Model of the Rehabilitation Pathway - Nationally and Regionally Swallowing Guidelines Bedside Signs Redesign Capacity Development in Audit, Research and Innovation Value: Compassion and Empathy Cognitive Educational Group for Families/Carers of Patient s with Neurological Condition in Inpatient Rehabilitation Pets As Therapy Team Reflection and Learning on Service Users with Significant Behavioural or Mental Health Issues: Neuropsychiatry Values in Practice Value: Honest and Trust Improving Timely Discharges and Patient and Family Experience Through the Introduction of a Discharge Coordinator Single Point of Contact (SPOC): the right patient, at the right place at the right time Rehabilitation Co-ordinators Embedding Patient and Staff Experience into Network Culture

3 Welcome to CMRN s Learning Together, Working Together; Book of Best Practice We are delighted to introduce you to our first annual Learning Together, Working Together; Book of Best Practice It is widely recognised that patients following traumatic injury or illness need a programme of rehabilitation at the right time, at the right place and by the right team to maximise their outcomes. We at the Cheshire and Merseyside Rehabilitation Network (CMRN) have co-created a new model of care to make his happen, with a co-ordinated pathway from hyper acute to community, based on our patients rehabilitation needs not diagnosis. The CMRN is delivered by seven partners across the region, in collaboration with NHS England and local Clinical Commissioning Groups. We have developed a joint strategy with Our Vision, Our Purpose at the centre of everything we do and it is our commitment to deliver high quality evidence based specialist rehabilitation care. The Book of Best Practice is part of the Network s Our Vision, Our Purpose which includes our values that set out how we will work, regardless of the role we hold or at which stage we are in the patients rehabilitation journey. Our Network is the first of its kind nationally with a commissioned co-ordinated pathway from hospital to community. It is important that we share and learn from good practice to provide the best possible rehabilitation care and positive experience for our patients and their families and carers. This year our Network received national recognition for our approach and outcomes in specialist rehabilitation care. A HSJ Award for the Redesign of Specialist Rehabilitation Services has provided us with a great opportunity to share our collaborative and co-ordinated pathway across the wider NHS. We would like to thank all staff working across the Network for sharing their case studies within this book which are a testament to the great service improvements we are making every day towards effective patient centred and compassionate specialist rehabilitation care. Our Values: Working Together for Patients Respect and Dignity Empowerment Commitment to Quality of Care Compassion and Empathy Honesty and Trust Each case study within this Book has been attributed to a specific value, although it is recognised that most encompass all aspects of all values. Dr Ganesh Bavikatte Rehabilitation Consultant and Clinical Lead, WCFT/ CMRN Alison Price Network Manager, CMRN

4 Working together Respect & Dignity Empowerment Quality Care Compassion & Empathy Working Together for Patients We all, staff, families, carers and patients, do our best to pull together, sharing knowledge and resources to deliver the best possible care tailored to patients needs. Working as a co-ordinated team across the pathway, we recognise the importance of partnership working in achieving success, be that with staff, patients, families, carers, commissioners or any other partners to maximise clinical outcomes and provide a positive staff and patient experience. Wherever patients are along their, the Network is always right behind them. Honesty & Trust

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6 Working together Development of an Assessment Toolkit for the Use of Assistive Technology with Complex Rehabilitation Patients Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre) Assistive technology is considered an appropriate intervention to aid rehabilitation. The team identified a need to explore a more cohesive way to assessment that involved an interdisciplinary team (IDT) approach to assessment and provision of assistive technology for patients within an inpatient rehabilitation setting. We worked with North West Assistive Technology in order to identify suitable equipment that could form a toolkit of equipment for a range of ability. A working party was established to commence work on an assessment process that captured the IDT input and ensured that patients progression through an appropriate hierarchy of skills and ability was considered. Team representation included Physiotherapy, Occupational Therapy and Speech and Language Therapy. Staff report more confidence in assessment and provision of assistive technology. We now have an established kit of equipment to aid assessment that can be loaned for use during inpatient admission. Referrals for communication aids and assistive technology are more informative and timely. To trial the assessment form and identify further technology and opportunities for use in the inpatient rehabilitation units across the Network. Pip Wilford, Clinical Specialist Occupational Therapist pip.wilford@thewaltoncentre.nhs.uk

7 Working together Facilitating Seamless Transfer of Care into the Community Specialist Rehabilitation Community Service for St Helens and Knowsley CCGs (Bridgewater) Share best practice through regular quarterly meetings between the inpatient unit and community service specialist rehabilitation teams. Facilitate seamless transfer of care from hospital into the community. Improve collaborative working. Improve communication between teams. Increase staff understanding of the different treatment approaches within the rehabilitation setting and community setting. Update staff on patients experience, progress and outcomes in the community service. Increase staff awareness of the whole patient journey. Representatives of different professionals attended planned quarterly meetings. Staff from both the Specialist Spoke Service and from the Community Specialist Rehabilitation Service attended the meetings to share patient experiences and to review the patient journey. A small selection of patients were identified and their journey from spoke to community services are discussed in detail to identify: How the transition was facilitated Were the appropriate people involved? Was the intervention timely? What went well and what could be done differently What intervention from the interdisciplinary team patients have received along their pathway i.e. vocational rehabilitation Staff have met and found these meetings helpful in improving collaborative working and understanding the different service pressures across the Network. Patient flow has improved due to staff having a better awareness of the services available along the pathway. Sharing of best practice across the inpatient and community services to inform future service developments. To continue to attend and participate in regular meetings with Seddon Suite Spoke Rehabilitation Unit. Rachael Cross, Occupational Therapist rachael.cross@hsthpct.nhs.uk Sue Lightfoot, Service ManagerManager: sue.lightfoot@bridgewater.nhs.uk

8 Working together Patient Journey Animation Network-wide: Specialist Rehabilitation Hub (The Walton Centre), Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) and Extended (Partnerships In Care) Units and Community Services (Bridgewater, Mersey Care, The Walton Centre) To produce an animated video that aims to support patients and their family in their understanding of rehabilitation and the pathway. The animation includes members of the team who support and empower patients in their rehabilitation programmes. Staff working across the hospital and community services shared their ideas for the animation, working with an animation team. The animation features a patient called Peter and highlights the holistic care planning approach that involves an inter-disciplinary team of specialist rehabilitation health and social care professionals. Produced a short 4-minute animation that follows Peter through his admission, assessment and management stages of rehabilitation, including joint development/review of goals to optimise his outcomes. The animation s creative design, script and voice over were all created by the group. The Rehabilitation Network and its purpose is promoted in an effective and engaging way to inform all stakeholders around the key elements of the services and reinforces the values of the Network. The animation has become an invaluable resource for rehabilitation healthcare professionals to share with patients and their families, particularly at referral stage. The animation is available on the Rehabilitation Network website and on YouTube. Comments from patients include: I didn t really understand what rehabilitation meant but the animation helped me to see what was involved and who would be helping me to get me back on my feet. Comments from staff include: the animation is a good way to give the patient and their family an overview of the rehabilitation journey and what to expect ; an effective way to explain what the Rehabilitation Network is about to other healthcare professionals and potential referrers. The animation has been shown at a local cinema at an event organised for the public, commissioners and healthcare staff as part of an ongoing rehabilitation awareness sessions delivered by the Network. The Network plans to continue to promote the animation across Cheshire and Merseyside as well as with the wider NHS. Angela Harrison, CMRN Performance Information and Research Manager angela.harrison@thewaltoncentre.nhs.uk

9 Working together Improving Discharge Management Spoke Specialist Rehabilitation Unit - Seddon Suite (St Helens Hospital) Ensure all information is available to the ongoing treating team following discharge or transfer. Ensure the information and format is clear for patients to empower them with the choice to share with outside agencies/ care providers. Reduce the length of time discharge summaries are completed and sent out to GP/ongoing treating team and given to patients to discharge. Reduce the number of discharge documents for each patient. Ensure medical information is easy to read and accessible for the patient. Content and layout of form was reviewed and amended following feedback from all disciplines within the team. Undertook a pilot for 1 month using the new template. Reviewed and amended the template following the pilot and feedback from staff and patents to include all relevant key aspects of care and disciplines. of form changed and all disciplines gave feedback. New template piloted for 1 month. Included more relevant key aspects of care. Included Rehab Co-ordinator section. Excellent verbal feedback given from other areas of the Network, GPs and outside agencies, community teams. Patients have increased level of understanding and summary of their rehabilitation journey. The revised Discharge Summary Template, which incorporates the patients rehabilitation prescription and passport will be piloted in the other inpatients units across the Network. Dr Helen Banks, Consultant in Rehabilitation Medicine helen.banks@sthk.nhs.uk; Nicola Parkinson, Rehabilitation Co-ordinator; nicola.parkinson@sthk.nhs.uk Margaret Hodgson, Secretary margaret.hodgson@sthk.nhs.uk

10 Working together Enhancing Collaborative Working Within and Across Teams Network-wide: Specialist Rehabilitation Hub (The Walton Centre), Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) and Extended (Partnerships In Care) Units and Community Services (Bridgewater, Mersey Care, The Walton Centre) It was acknowledged that the interdisciplinary teams working across the Network pathway share their knowledge and experiences with one another on a continuous basis. We wanted to hold service level workshops which focused on collaborative working and learning together both as a service team and as a Network team to identify areas of strength and learning as well as opportunities for development. Service level workshops were held with each of the seven teams on their site to enable the maximum number of staff to attend. The workshops provided a semi-structured approach with key questions for staff to discuss current strengths, challenges, areas for development, personal commitments and topic suggestions for a forthcoming Network Staff Event. A further meeting was held with each service team to discuss the feedback from the workshop and agree actions, based on what each team wanted to achieve. A combined Network action plan was produced and is being implemented by a Network Task Group. Feedback and action plans from the workshops were reviewed to identify common themes which provided the basis for the Network Event: A patient journey across hospital and community services to describe the roles and responsibilities of each team along the pathway Development of an accredited Network Education Module Development of an information forum to support effective communication and learning across the hospital and community services Development of effective inter-disciplinary working processes. A strategy review of progress made against our service objectives in Identification of service priorities and development of the Network Work Programme. The workshops and Event provided staff with an improved understanding of roles and responsibilities across the service pathway. Action plans have been developed that recognise the value and contribution of all partners and supports active involvement of staff working across the pathway. A number of actions relating to education and training, communication and operations were identified and a Task Group has been established to implement these and provide assurance to the Network Operational Committee and Board that improvements are being realised and sustained. Examples include: Development of therapy, nursing and reflective practice forums Identifying shadowing opportunities and rotations for staff across the pathway services Supporting effective communication internally and promotion of Network activities externally across the wider NHS Management of delayed discharges and pathway transfers to improve patient experience

11 A Work Programme for has been produced based on staff feedback which identified an agreed set of shared goals and priorities. Feedback has been really positive with staff reporting that this kind of co-production supports co-ordination of service delivery and effective inter-disciplinary team working and, ultimately, better outcomes for our patients and families/carers. Staff comments include: It was a good opportunity to see the patients whole journey and final outcome It s always good to meet as a network to share knowledge and skills and have the opportunity to be part of the planning of the Education Programme It makes me feel valued that my opinion counts when planning the work programme and key actions for the next year. The Network will continue to implement the actions plans, progress the development of an education programme with a local university and develop an information forum with our IT teams. The Network plans to develop a programme of workshops over the year with continued emphasis on collaborative inter-disciplinary working Alison Price, CMRN Manager alison.price@thewaltoncentre.nhs.uk Angela Harrison, CMRN Performance, Information and Research Manager angela.harrison@thewaltoncentre.nhs.uk Julie gibbons, CMRM Rehabilitation Co-ordination Service Team Leader julie.gibbons@thewaltoncentre.nhs.uk

12 Working together Respect & Dignity Empowerment Respect and Dignity We acknowledge patients needs, aspirations and priorities at all times. We aspire to deliver excellent care every day in practice. This will be focused on respect and dignity. For patients, families, carers and staff We all have a duty to do our best to understand what makes each other tick. Quality Care Compassion & Empathy Honesty & Trust

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14 Respect & Dignity Developing Person Centred One Page Profiles Clinical and Neuropsychology Team (Mersey Care) to Specialist Rehabilitation Hub (The Walton Centre) and Spoke (St Helens and Broadgreen Hospitals) Units We wanted to use person centred techniques to get to know what is important to a person and how we can best support them during their time within hospital or community services across the Rehabilitation Network pathway. By developing a One Page Profile for each patient this demonstrates what is important to each individual and how they can be supported in the best way to help them to get the most out of their rehabilitation. The One Page Profile is developed with patients, families and carers providing the information. A number of therapists, therapy assistants, nursing assistants, Rehabilitation Co-ordinators and all Psychologists working across the network pathway have received training. Every patient has a One Page Profile developed on admission to the Units. To continue to train staff working in the inpatient and community specialist rehabilitation services across the Network, and evaluate how One Page Profiles are received by patients, families and staff. The Network plans to use the One Page Profiles to support the development, implementation and evaluation of a recreational activities pilot programme in Two day training sessions delivered by an accredited facilitator to staff twice a year since 2013 when the Network began. Following the training, One Page Profiles were developed with each patient on the Units and used part of their rehabilitation programme. Psychologists lead the development of the Profiles in collaboration with other members of the interdisciplinary team, patients, families and carers. Dr Samantha Townsend, Clinical Psychologist sam.townsend@thewaltoncentre.nhs.uk

15 Respect & Dignity Patient Forum Spoke Specialist Rehabilitation Unit - Phoenix Centre, (Broadgreen Hospital) The nursing, therapy and medical staff wanted to provide an opportunity for patients to help shape and influence their rehabilitation service. It was acknowledged by the team that each patient will have different needs, views and experience of rehabilitation and the aim of a patient forum would be to facilitate them to take ownership of their rehabilitation programme during their stay on the Unit The patient forum was planned to take place once a month in the day room on the Unit where all patients and their families/visitors were invited to attend. Prior to each forum meeting an agenda was developed based on feedback and suggestions from patients. Patients were encouraged to suggest anything that was on their mind about the Unit, which could include meal times, equipment, day room facilitates, therapy times etc. A member of staff chaired the meeting and encouraged patients, families/visitors to discuss the agenda topics. A guest speaker was invited to each forum, which included representatives from charities/patient associations (e.g. Spinal Injuries Association) or a previous in-patient who spoke about their rehabilitation journey. Minutes were taken and typed up for each forum to ensure that any actions from the agenda topics were followed up. The process of setting up the forum, implementing and listening to the ideas of the patients and their families/visitors has been an invaluable experience. We have found that patients want to be involved to shape and influence rehabilitation services provided on the Unit. Not all patients were able to discuss their views in a group setting due to their complex rehabilitation needs so their involvement is facilitated where possible. Patients reported that they wanted to take more ownership of the forum. It was agreed that future form meetings will be patient led; facilitated by a member of staff with the patient as the Chair. A male and female patient will identify agenda topics following informal discussions with other inpatients. On discharge a new Chair will be identified. The forum has been a great success with many positive changes identified and implemented. These included a television programme planner and improvements to the therapy timetables. We have been delighted that some patients plan to come back and support the forum. Patients also wanted to get involved in service evaluations for the Unit. It has been agreed that initial evaluations will focus on the patient therapy timetable/board, the day room/living space and meal times. Jon Mavers, Physiotherapist jon.mavers@rlbuht.nhs.uk Rachel Taylor, Dietitian rachel.taylor@rlbuht.nhs.uk Helen Dwerryhouse, Occupational Therapist helen.dwerryhouse@rlbuht.nhs.uk Claire Hendry, Rehabilitation Co-ordinator claire.hendry@rlbuht.nhs.uk

16 Respect & Dignity Mindfulness-based Relaxation Group Spoke Specialist Rehabilitation Unit - Phoenix Centre (Broadgreen Hospital) To introduce the concept of mindfulness and enable patients to practice a range of mindfulness techniques with the aim of reducing anxiety and low mood and provide patients with tools to manage their emotional wellbeing. These techniques are evidence based and developed in line with evidenced interventions. The group was planned on a weekly basis for one hour and was accessible to all patients following initial assessment by the psychology team. Group sessions were run on a drop-in basis allowing patients to flexibly join sessions as required and are supported by staff to join the group. The group sessions involved patient discussion around recognising and managing personal stress, anxiety and low mood and introduced a range of mindfulness strategies. The group focused on different aspects of mindfulness and required patients to engage with a variety of mindfulness meditation techniques, in addition to engaging in practical activities. Patients were provided with a CD and tasks to complete between group sessions in order to encourage personal, independent practice. The mindfulness group is a popular group on the Unit and many patients who have been involved have continued to utilise and practice the techniques independently and following discharge from hospital. Patient comments have been positive, including: The mindfulness group was useful for my day-to-day life ; I found the group useful. It highlighted areas where I was weak and gave me ideas and practices to compensate for my weaknesses. It made me realise that I wasn't alone and I felt lucky and thankful I wasn't left with major difficulties. Mindfulness group was very interesting and helped me relax. Moving forwards, we plan to complete a quantitative study to evaluate the impact of the mindfulness group on clinical outcomes for anxiety and depression. This study would involve an 8-week programme to measure emotional wellbeing pre- and post- group attendance using the standardised Hospital Anxiety and Depression Scale (HADS). The aim of this study would be to provide further evidence of the benefit of mindfulness based interventions on inpatient rehabilitation units for individuals experiencing anxiety and depression. Dr Debra Ford, Clinical Psychologist debra.ford@rlbuht.nhs.uk Emma Dandy, Assistant Psychologist

17 The staff have been very kind and helpful and we have been very impressed with the level of care and rehabilitation. I was treated with respect. Mary Phoenix Centre Spoke Specialist Rehabilitation Unit (Broadgreen Hospital) 100% of patients strongly agreed/ agreed that staff involved them in setting their goals and decisions about their rehabilitation care 100% of patients/carers reported that their medical condition and rehabilitation treatment programme was clearly explained This is the type of service that all individuals with complex needs can benefit from. The service is the most person centred that I have ever observed. Malcolm Complex Specialist Rehabilitation Hub Unit (The Walton Centre) 94% of patients/carers rated their overall satisfaction with the rehabilitation service as very satisfied/satisfied Fantastic care with a real emphasis on dignity Paul s Family Hyper Acute Rehabilitation Hub Unit (The Walton Centre)

18 Working together Respect & Dignity Empowerment Quality Care Compassion & Empathy Empowerment We actively involve patients in their care, as well as their family/carers, giving information, support and guidance that empowers them to effectively manage their recovery and improve quality of life. We empower staff to do their jobs to the best of their ability. Ensuring staff are appropriately trained and supported, feel valued and empowered to make decisions in the best interest of patients is vital. Engagement and involvement is essential in empowering patients and staff. Honesty & Trust

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20 Empowerment The Use of 'e Diaries' to Facilitate Patients Rehabilitation and Therapy Processes Hub Complex Rehabilitation Unit (The Walton Centre) Patients transferred to the CRU are currently assessed jointly by Physiotherapy and Occupational Therapy on admission. This provides a variety of baseline findings from which to determine and progress the appropriate interventions. During their ongoing care, patients receive regular updates on their abilities both informally from the therapists and through goal setting meetings. They also receive instructions and advice surrounding various aspects of care that maybe practised outside of directed therapy sessions. All of these methods serve to inform the patient and empower them in terms of self management. During periods of long-term rehabilitation, patients often report that a visual representation of where they had come from and where they were now would be extremely beneficial. This has the potential to assist in them understanding their progress, in providing them with a record of their abilities and allow them a method of maintaining focus during difficult times. Health Care Professionals in Rehabilitation also report benefits on the use of visual media in providing objective evidence of change, enhancing adherence to prescribed care, allowing repeated viewing of patient presentation for complex analysis and allowing them a method of maintaining focus during difficult times. The aims of the project were to: 1. Introduce the use of 'e Diaries' for patients on the CRU to allow visual representation of initial and progress assessments, intervention programmes for individual practise and other professional advice supplements to further support empowerment and self-management. 2. Improve the care information available to patients. 3. Enable patients to view their progress and interventions in a chronological order in their own time and within the privacy of their chosen space. Developed the e-diary key elements with stakeholders. Recorded the patient s physical abilities in Physiotherapy and Occupational Therapy within days following admission and followed up with diary recordings every 4 weeks until just prior to their discharge. As appropriate, it was possible to record other specific therapy sessions such as exercises and relaxation instructions. Provided patients with an i pad to use during their time on the Unit to watch their session recordings at their convenience. Upon discharge they will be able to access the recordings from their home computer using a password protected, Trust computer network, where their recording will also be stored as part of their case notes. Those patients who do not have access to a home computer were given a complete copy of their e Diary on DVD. Patient and Staff Satisfaction Questionnaires have been developed to support data collection and analysis upon completion of the pilot. Initial comments from patients has been positive: It was good to see the before and after progress I had made ; It was good to show my husband my progress and it gave me encouragement Undertake full review in April 2016, using the findings to modify and extend the e Diary to include additional elements prior to roll out, to include other disciplines. Jo Haworth, Clinical Specialist Physiotherapist jo.haworth@thewaltoncentre.nhs.uk

21 Empowerment Development, Implementation and Evaluation of My Rehab File Spoke Specialist Rehabilitation Unit - Phoenix Centre (Broadgreen Hospital) In June 2013 the team wanted to develop a file for patients to help them track and organise their rehabilitation goals and journey. The team (Psychology, Nursing, Physiotherapy, Occupational Therapy, Speech and Language Therapy and Dietetics) developed a file that included information about the Unit, the role of each profession to support patients rehabilitation programmes and the importance of agreeing rehabilitation goals. The first edition of My Rehab File went live with patients in June It has been evaluated, modified and improved to reflect the Units values of being patient centred, open and honest. My Rehab File now includes expectations of patients and staff, contacts for charities and support groups, and a likes and dislikes questionnaire for food and drink. My Rehab File is provided to all patients on admission to the Unit. The Therapy Assistants support the patients and their families/carers to understand the purpose and content of the file to maximise its use. The therapy team encourage all patients to consider achievable goals in each therapy session and at goal setting and family meetings to record in their file. In the CMRN Peer Review in 2013 it was agreed that the My Rehab File was an effective document to support the rehabilitation programme of each individual patient across the Network and it was acknowledged that it was an initiative from the Phoenix Centre. The team will continue to review, evaluate and revise the My Rehab File with staff, patients and their family/carers to support a high quality rehabilitation service. Jon Mavers, Physiotherapist jon.mavers@rlbuht.nhs.uk Rachel Taylor, Dietitian rachel.taylor@rlbuht.nhs.uk Helen Dwerryhouse, Occupational Therapist helen.dwerryhouse@rlbuht.nhs.uk

22 Empowerment Development of My Rehabilitation Folder for Patients and their Families and Carers to Support their Rehabilitation Journey Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre) Improve awareness of the rehabilitation process and goal setting amongst patients and their families. Better co-ordination of provision of information to support rehabilitation. An initial survey was completed which indicated poor awareness of actual therapy goals amongst patients and families. A working party was established to develop a pilot folder with positive feedback received. General information about the Network, team and key aspects of the rehabilitation journey were included. Patient and family/carer involvement to review documents. Worked with Information governance regarding contents and ensuring an appropriate framework for monitoring usage. Patient outcome measure piloted and adjusted to measure effectiveness and awareness. Use of Rehabilitation Network animation to link folder with other patient information. Patients and their families report they have found the information sections useful. On-going adjustments are being made to reflect patient and family/carer feedback and to include additional information such as therapy groups, one page profiles and a contact sheet for family and the team. Other services within the Rehabilitation Network have expressed interest in using a similar structure and this is being explored. Team support for the use of the folders has improved, with awareness raised by regular training sessions and updates. Formalise use of outcome measure pre and post provision of folders. Continue to work with information governance on the contents of the folder. Pip Wilford, Clinical Specialist Occupational Therapist pip.wilford@thewaltoncentre.nhs.uk

23 Empowerment Movement Group Development Spoke Specialist Rehabilitation Unit - Seddon Suite (St Helens Hospital) Promote exercise opportunities in a group setting. Increase social interaction. Reduce stress/anxiety associated with physical activity. Promote communication between patients and staff. Develop key areas of fitness to support the achievement of functional goals. Monitor efficacy with appropriate outcome measures. Designed a protocol based on patient need at time of development considering equipment needs/cost/ health and safety. Identified appropriate outcome measures which could be easily implemented Created a folder containing records and resources. Involved junior members of staff in further development projects and delivery of training. Implemented a weekly group, initially run by two qualified members of staff. Positive patient feedback. Successful implementation of a weekly movement group. Staff to patient ratios reduced, allowing extra time for non-clinical duties. Junior members of staff worked together supporting evidence for group therapy and ensure assistant members of staff were competent in assisting with the running and recording of the group, through in service training and supported group sessions. To audit patient feedback using patient satisfaction questionnaire which is currently in development. To implement advanced level group and chair based group in response to varying level of physical abilities of patients on the unit Katy Thompson, Senior Physiotherapist katy.thompson@sthk.nhs.uk

24 Empowerment A Self-Management Programme for Patients Following Traumatic Injury or Illness Hub Complex Rehabilitation Unit (The Walton Centre) 1. Improve patients' self-confidence when managing their complex long term condition, initiated in the early stages of in-patient rehabilitation. 2. Ensure the inter-disciplinary team prioritise patient involvement and empowerment in managing their complex, long term condition. 3. Develop an in-patient programme of structured and focused intervention aimed at supporting patient self-management and empowerment. 4. Collect and collate patient-reported data surrounding the efficacy of a structured, in-patient self management programme in terms of both psychological and performance outcomes. 5. Ensure inter-disciplinary collaboration on patient interventions focused around National priorities. Data Collection will take place at baseline and after completion of the programme. Measures utilised to capture outcomes will include the Day to Day Activity Self-Efficacy Measure and the Canadian Occupational Performance Measure. Regular self-reported confidence will be reported using a visual analogue scale. The aim of this will be to facilitate goal setting and review rather than to evaluate programme efficacy. Launch Pilot April Jo Haworth, Clinical Specialist Physiotherapist jo.haworth@thewaltoncentre.nhs.uk For patients transferred to the Complex Rehabilitation Unit it was anticipated that the programme development would benefit from a collaborative team approach including a variety of health care professionals and patients working in partnership on concept design. A focus group including representation from physiotherapy, occupational therapy, speech therapy, psychology, dietetics, pharmacy, mental health liaison, patients and their family/carers worked on the evolution of ideas, the design of key elements and the programme structure. The delivery methods for each element of the programme were developed based on evidence supporting the inclusion of educational elements, goal driven achievements and individualised support sessions.

25 Empowerment Lifestyles Group Joint Occupational Health and Dietitian Patient Therapy Sessions Spoke Specialist Rehabilitation Unit - Phoenix Centre (Broadgreen Hospital) The team wanted to provide new ways to deliver therapy sessions to help improve therapeutic outcomes and the patient experience. Therapy is patient centred, adaptable and flexible to meet the complexity of patient conditions. This has resulted in the team developing a wide range of patient groups that are led by all disciplines and grades of staff from therapy assistants to discipline leads; one of the groups the Team wanted to develop was the Lifestyles Group. The aim of the group would be to provide a fun, interactive, educational therapy session that is therapeutic and purposeful. Occupational Therapists and Dietitian worked closely together to develop the Lifestyle Group. Both disciplines highlighted the therapy outcomes that would make the session therapeutic for the patient. The team also wanted to make sure that the group was fun and enjoyable. The group was planned to run once a week with a different focus (e.g. pitta, healthy pizzas, fruit salad, fruit muffins). that also coincides with seasonal celebrations (e.g. Christmas, Halloween). We discussed which patients are suitable to attend the group and what their therapeutic outcome measures would be (e.g. involved in chopping/ mixing to contribute towards upper limb work). Promote healthy eating to provide a supportive environment for patients. After each session an evaluation form was provided to each patient. The feedback has been very positive and patients have suggested ideas for future sessions. Patient feedback includes: Social meeting group and healthy eating for our body ; More people to attend and increased volume of the project (question about what could be improved) ; Brilliant,had things I d never eaten before and would defiantly buy them when I go home. Staff feedback includes: It has helped me see the importance of promoting healthy eating during a patients stay on the unit ; As Occupational Therapists we can support the Dietitian to promote healthy eating on the unit, for example during kitchen assessments or shopping ; The group helps me to formulate further treatment plans as you get to see the patient in a different light, you get to see the patients functional ability in a different way than to a standard functional assessment The group will continue to gain patient feedback to improve and develop sessions that provide innovative and enjoyable therapy for patients, including healthy eating education. A write up of the group will feature in Dietetic and Occupational Therapy professional magazines. Rachel Taylor, Dietitian rachel.taylor@rlbuht.nhs.uk Helen Dwerryhouse, Occupational Therapist helen.dwerryhouse@rlbuht.nhs.uk

26 Working together Respect & Dignity Empowerment Quality Care Commitment to Quality of Care We always strive to deliver evidence and experience based rehabilitation. We go the extra mile to provide high quality compassionate care that is safe, effective, holistic and person-centred, using patient, family/carer and staff experience to continuously drive service improvements. We support and challenge ourselves and others to do better. Compassion & Empathy Honesty & Trust

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28 Quality Care Upper Limb Management Pathway Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre) Streamline management approach to patients with neurologically damaged upper limbs. Standardise approaches when assessing an upper limb. Introduce and standardise communication, specific assessments and outcome measures based of evidence based practice. Commence patient and family/carer education group to assist with management of upper limbs. Highlight the importance of the management of the vulnerable upper limb to the inter-disciplinary team (IDT). Formed an upper limb working party between physiotherapy and occupational therapy across the Complex Rehabilitation Unit and Hyper Acute Rehabilitation Unit. Implemented vulnerable upper limb warning signs and communication handover sheets for the IDT. Formulated a standard upper limb assessment to be carried out on all inpatients with vulnerable/affected upper limbs. Using a standardised flowchart, identified appropriate evidence based outcome measures for pain, range of movement, spasticity/tone, function, sensation and power. Formulated a patient and family 6 weeks education group to be commenced with opportunities to learn anatomy, exercises, handling, personal care, sensory and Activities of Daily Living (ADL). Formulated a weekly exercise group including active exercises, functional electrical stimulation, functional tasks, constraint induced movement therapy and sensory corner. Improved awareness of the vulnerable upper limb amongst nursing staff, patients and their family/ carers. Streamlined standardised assessment and management of the vulnerable upper limb. Regular use and monthly review of appropriate and standardised outcome measures. Weekly education group on upper limb management for patients and family/carers, including information leaflets. Weekly upper limb activity and exercise group encompassing all types of vulnerable upper limbs. Developed a resource file of standardised outcome measures and evidence based practice. Complete 6 weeks education group and gain feedback from patients and family/carers. To support ongoing implementation of exercise group delivered jointly by Occupational Therapy and Physiotherapy and gain feedback from staff and patients. To undertake a review of the upper limb pathway and standardised outcome measures after three months. Jenny Farquhar, Physiotherapist jenny.farquhar@thewaltoncentre.nhs.uk Nicola Branscombe, Occupational therapist nicola.branscombe@thewaltoncentre.nhs.uk

29 Quality Care Patient Equipment Tracking System (PETS) Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre) Within the Rehabilitation Network the Occupational Therapists have access to a large provision of wheelchairs and varying accessories to complete postural and complex seating assessments for all patients on the Rehabilitation Units on a daily basis. Having such a varying caseload, changes in wheelchair and accessory provision for patients can become a daily occurrence and keeping safe and up to date documentation and record keeping of these changes became a time consuming job for all members of the team, taking time away from patient care. Alongside provision of this equipment, the occupational therapy team also have to keep record of servicing and maintenance agreements to ensure safety of patients, as well as weekly wheelchair checks for all issued equipment. It is therefore the reason why this process needed to be reviewed to create a more streamlined way of issuing and maintaining our current stock of equipment to improve the quality of the provision of equipment, while maintain patient safety. Initial discussions were held with the Head of Risk within the Trust to develop a barcode and scanning system which utilised the medical devices barcoding on wheelchairs. This was expanded further to include all the wheelchair accessories within the Rehabilitation Units. Development of a Patient Equipment Tracking System (PETS) with IT to accommodate the needs of issuing and electronically recording the pathway of wheelchair and accessory equipment. Work with the Trust s Lead for Research, Development & Innovation to source potential funding streams to assist with our new system, which led to the presentation and the approval of the pilot service of PETS within the Trust. The PETS system is now completed and in use on the Rehabilitation Units. The system allows for a number of different processes to be electronically recorded. When issuing equipment the Occupational Therapist scans the equipment required against the patient s hospital number, making an electronic record of date of issue, the issuing therapists name and the weekly check documentation record commences. When any equipment is due for a service, the PETS system s a reminder to the team leads one month prior to the servicing deadline to allow the organisation of the service to be completed. A bird s eye view of a piece of equipment history can be observed via an alternative app within the system. This shows an additional cost improvement benefit to the service as this electronic documentation will assist with identifying the most used and needed equipment within the Rehabilitation Units when renewal or demand facilitates new equipment for the therapy department. If a piece of equipment needs condemning, either due to expired shelf life or infection control for example, reasoning for this can be clearly recorded and provide evidence for future re-purchasing. The PETS system is currently in a pilot phase across the Rehabilitation Units. On review, this newly designed therapy equipment tracking system will be developed further and can be rolled out across the Trust, accommodating all patient and ward equipment across both Rehabilitation and Acute Services. Jennifer Hughes, Occupational Therapist jennifer.hughes@thewaltoncentre.nhs.uk

30 Quality Care Development of the Upper Limb Management Pathway Spoke Seddon Specialist Rehabilitation Unit (St Helens Hospital)? We wanted to identify, structure and co-ordinate the treatment options offered to patients at Seddon Suite whilst providing a uniformed approach regardless of discipline or grade in line with evidence-based practice. Reviewed current service provision and resource availability including listening to patient feedback and staff suggestions. Benchmarked our service against another leading service in the area of Upper Limb Management Developed an Upper Limb Pathway to identify the most appropriate treatment modalities available for the patient on Seddon Suite. Developed a central resource file to signpost the therapist to access further, more specific information regarding a particular treatment option. Purchased additional resources to support evidenced based treatment modalities Provided internal training to therapies team on pathway identification and treatment modalities Provided training and support to community therapy teams to further bridge the gap between in-patient and outpatient treatments The pathway has provided a framework to aid clinical reasoning ensuring all treatment options are considered. Development of the pathway has supported the service in remaining up to date with evidence base. Implementation of the pathway has improved equity of patient rehabilitation at Seddon Suite Specialist Rehabilitation Unit. Patient outcomes in relation to upper limb function have improved across all levels (low/ medium/high functioning). Patient feedback has been positive in relation to demonstrating a client-focussed approach. Handover of upper limb management into community setting has developed a more streamlined approach. Training provided has received an excellent response from staff with 100% reporting that they were totally satisfied that their personal aims and objective were met. Evidence from pathway outcome measures has been used to secure a bid for funding for specialist upper limb resources. Training will continue to be rolled out to rotational staff, whilst facilitating growth of specialist skills in senior staff. Alison Murray, Advanced Clinician Occupational Therapist alison.murray@sthk.nhs.uk

31 Quality Care The Role of the Social Worker to Enhance the Social Care Element of Patient Rehabilitation Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit, (The Walton Centre)? To ensure that all patients on the Hyper Acute Rehabilitation Unit (HARU) and Complex Rehabilitation Unit (CRU) have access to social work interventions and support whilst receiving a needs led assessment to facilitate a safe discharge to the most appropriate destination which meets their identified needs. By undertaking an assessment of need and sharing any outcomes or issues that are identified, the Social Worker has informed the decision making process alongside the interdisciplinary team (IDT) with discharge decisions and recommendations. On behalf of the patient, family and carers the Social Worker acts as an advocate to liaise with external agencies, signposting and supporting individuals to access social work involvement from all localities, wider social systems and community resources. The Social Worker attends the weekly IDT meetings, discharge planning meetings and goal review meetings. Early findings show the role of the Social Worker has enhanced both the patient and family/carer experience by providing timely and appropriate assessment to facilitate discharge from hospital. The social work role has guided the IDT in planning for social work interventions, decision making and or responding to identified issues such as housing, financial concerns, packages of care and installation of Telecare/assistive technology services. Furthermore, the social work role has complimented the role of the Rehabilitation Co-ordinators through collaborative working between health and social care. To work with the IDT to identify and resolve any barriers, gaps or delays in the process of social work involvement or interventions. To build relationships with and improve knowledge of external agencies, wider social systems and community resources to ensure best practice and better outcomes for patient discharges. Viola Tosh, Social Worker viola.tosh@thewaltoncentre.nhs.uk

32 Quality Care Introduction of Therapeutic Specialling Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre) The increasing use of specials is aligned with the changing nature of disease and demand for services recognised by Lord Darzi (2008). Less consideration in the literature has been given to the use of special observation alongside other intervention strategies to manage challenging behaviour (Stewart et al, 2011), perhaps because it is easier to just assign a nurse to a patient with little consideration to implementing further safety measures. Lack of familiarity has been identified as a reason for hostility towards agency staff whom perform special observation (Dodds and Bowles, 2001) and supports the need for good communication with patients to alleviate some of the negative consequences associated with intruding on patients privacy for extended periods (Duffy, 1995, Fletcher, 1999). Staff now have access to activity resource boxes and are actively encouraged to utilise them with patients when performing special observation. Although it has not reduced the need for 1-1 care (this was not intended) it is envisaged that it has enhanced both the patient and staff experience. Whilst reducing the perception that special observation is considered negative, which patients often relate to the level of intrusion and restrictions involved (Cardell and Pitula, 1999). Continue to promote therapeutic specialling across the Network and share ideas and good practice to be implemented throughout. Sarah Flynn, Matron sarah.flynn@thewaltoncentre.nhs.uk We wanted to achieve greater engagement with patients which would encourage nurses to view the special observation role as more positive and therapeutic (Vrale and Steen, 2005) and enhance the overall patient experience. We reviewed current practice and identified the need for additional resources to assist when performing special observation of patients. A resource box was purchased for each area consisting of activities and games that staff can use to engage with patients when performing special observation. Neuropsychology and Therapy Teams provided some education and training to staff around choosing suitable activities for patients.

33 Quality Care Implementation of Goal Attainment Scale Spoke Seddon Specialist Rehabilitation Unit (St Helens Hospital) Training opportunity for all staff to use goal attainment scale as part of day to day practice. To provide an improved structure to goal setting meetings on the ward for both patients, their families/carers and staff. To develop a standardised framework for goals setting. To provide fluency in structure throughout the rehabilitation network in line with hyper acute and complex rehabilitation units Working party identified need for implementation and structure for roll out to staff on the unit. Gathered relevant documentation required to develop training programme. Used skills of staff who have previously used goal attainment scale in practice to roll out training. Pilot whereby a select number of patients trialled use. Developed power point presentation and ran 2 training days run for all staff to attend. Added training to band 5 in-service training to be continuously rolled out every 6 months. Developed system for storing goals on local computer network drive. Provided paper work for staff to document goals Patients attended goal setting meetings every 4 weeks and goal attainment scale goals are discussed and agreed within therapy sessions and within this meeting. New therapy staff are receiving training on goal attainment scale as part of the in-service training programme. GAS is being stored on local Network. To evaluate patient experience with regards to goal attainment scale. To ensure consistency across staff groups with implementation of goal attainment scale an undertake an audit. Michelle Gledhill, Specialist Occupational Therapist michelle.gledhill@sthk.nhs.uk

34 Spoke Seddon Specialist Rehabilitation Unit (St Helens Hospital) We wanted to implement Constraint Induced Movement Therapy (CIMT) within the service as a high level rehabilitation technique to reduce functional deficits in the affected arm of patients affected by stroke. CIMT - Constraint of the unaffected upper limb for 90% of waking hours for two weeks whilst training the affected arm for 6 hours each weekday during this period (Taub et al, 1993). Reviewed current high level treatment modalities and compared these to nationally reported CIMT outcomes and evidence. Attended external training on the implementation of CIMT as a treatment modality. Developed a CIMT Pathway and central resource file for Seddon Suite including the following: CIMT screening checklist CIMT Patient Information Handouts CIMT Contractual Agreements for patient and carer CIMT Goals List Pre-CIMT assessments Pre and post-cimt outcome measures Provision of daily timetable Provision of restraint Post-CIMT reviews Post-CIMT Patient Self-Evaluation Purchased additional resources to support evidenced based treatment modalities. Provided training to: therapies team on pathway identification and implementation of CIMT; nursing team to support the patient undertaking CIMT; and community therapy teams to further bridge the gap between in-patient and outpatient treatments. Quality Care Constraint Induced Movement Therapy for the Patient with Higher Level Upper Limb Function Completed CIMT treatment with four patients to date. Successful outcomes with all four patients who have undertaken CIMT treatment. Feedback has been provided to Seddon Suite and Specialist Community Rehab Team via case study with following patient outcomes: Significantly increased active range of movement within affected upper limb across shoulder, wrist and digits over the two week period: Shoulder flexion increased by 30 to 150, extension by 10 to 55, abduction by 35 to 125, external rotation by 20 to 90, internal rotation by 15 to 60. Elbow Full range pre-cimt Wrist flexion increased by 40 to 80, extension by 30 to 70, radial deviation by 10 to 20, ulnar deviation by 15 to 30. Reduced digit flexion/extension across all joints pre-cimt, full range achieved post-cimt. Significant improvements in outcome measures as follows: Action Reach Arm Test, 44/57 to 55/57 ArmA Difficulty Rating, 28 to 3 9 Hole Peg Test, 73 seconds to 45 seconds VAS Ease, 4.3 to 8.3 VAS Satisfaction, 3.6 to 10.0 Timed lids on/off, 48 seconds to 20 seconds Timed cards, 28 in 60 seconds to 32 Timed blocks, 6 in 60 seconds to 8 We will continue to use this treatment modality with in-patients on Seddon Suite with the future aim being to develop it further into the Outpatients clinic. Training will continue to be rolled out to rotational staff, whilst facilitating growth of specialist skills in senior staff. Alison Murray, Advanced Clinician Occupational Therapist alison.murray@sthk.nhs.uk

35 Quality Care Urinary Catheter Diary Hyper Acute Rehabilitation Unit (The Walton Centre) We wanted to minimise the possible risk of infection that may occur during the insertion of a urinary catheter, keep a record of the maintenance of the catheter whilst insitu and ensure it is removed as soon as it is no longer needed. This is vital as catheter associated urinary tract infections compromise a large proportion of healthcare associated infections and can occur whether a person has a short-term or a long-term catheter insitu. To continue to use the diary as it has proved to be a successful tool but to review/improve the document based on staff and patient feedback. To continue to audit on a daily basis to ensure full compliance of staff using it. Sister Lynn Thomson, Charge Nurse lynn.thomson@thewaltoncentre.nhs.uk Carl Smith, Nurse Ward Manager carl.smith@thewaltoncentre.nhs.uk With the help and guidance of the Infection Control Team, a Urinary Catheter Diary was implemented on the Hyper Acute Rehabilitation Unit and the Complex Rehabilitation Unit in October Our particular group of patients are felt to be more vulnerable and at risk of developing infection and therefore this was a tool to hopefully help prevent this. On each shift (3 per day) a RGN is responsible for the completion of the diary. After discussion with our Infection Control Team it has been found that after implementation in October 2015 we have had zero incidences of urosepsis for the months of November December 2015 and January With the help and guidance of the Infection Control Team a URINARY CATHETER DIARY was implemented on LIPTON ward and the CRU in October Our (3 per day) a RGN is responsible for the completion of the diary.

36 Quality Care Creating Video Tours to Support People Following Traumatic Injury or Illness for Admission to an Inpatient Rehabilitation Unit Network wide: Specialist Rehabilitation Hub (The Walton Centre) Spokes (St Helens, Broadgreen and Clatterbridge Hospitals, and Extended (Partnerships in Care) Units To create short video tours of each inpatient rehabilitation unit aimed at patients and their families/carers to support/prepare them for their rehabilitation, introducing them to the Unit and team when they cannot physically visit the Unit before admission. Created video tours include members of the interdisciplinary team (IDT) who work together to provide holistic rehabilitation programmes. The information regarding the team was formatted and delivered in such a way that it would be meaningful and person-centred. The IDT includes Rehabilitation Consultants, Doctors, Nurses, Occupational Therapists, Physiotherapists, Vocational Rehabilitation Therapist, Speech and Language Therapists, Dietitians, Psychologists, Mental Health Liaison Nurse, and Rehabilitation Coordinators. Filming was taken of relevant aspects of the rehabilitation programme including: Occupational Therapy and Physiotherapy Gyms Activities of Daily Living areas Dining and recreational areas Gardens Wards and bedrooms Goal setting meetings Inter-disciplinary teams meetings The scripts, creative direction and acting were created by the staff involved. The video tours show the units, members of the rehabilitation team and elements of the rehabilitation programme, taking away the fear for patients and their families/carers of the unknown. The films are helpful as a tool for questions from the patient and their family on their next phase of rehabilitation. Able to direct health care professionals and referrers to the videos to increase their awareness of the rehab network units. Feedback received from patients, families and staff has been extremely positive. Comments from patients and their families include: Helpful to see the Unit we re discussing ; Less anxious now I ve seen the Unit and some of the staff members I ll be working with. Comments from staff include: As a Rehabilitation Co-ordinator the video tours are a more effective way to describe the next step in someone s rehabilitation journey by being able to actually show it to them. The video tours are shown on referral prior to admission and on pathway transfers by the Single Point of Contact and the Rehabilitation Co-ordinators. They are available on the Rehabilitation Network website Continue to promote the video tours across the Network footprint. Angela Harrison, Performance Information and Research Manager angela.harrison@thewaltoncentre.nhs.uk

37 Quality Care Peer Review Programme Network wide: Specialist Rehabilitation Hub (The Walton Centre) Spoke (St Helens, Broadgreen and Clatterbridge Hospitals, and Extended (Partnerships in Care) Units An internal check on compliance with service specification standards. We implemented a peer review approach to identify and address any issues and share good practice A Peer Review Programme was developed. The schedule included visits to four inpatient hub and spoke rehabilitation units. An internal six month review was undertaken to identify any issues at an early stage and provide staff with the experience of what the peer review would include. A Peer Review Panel Inspection Team included a senior commissioning manager (NHS England for the Hub Peer Review and Clinical Commissioning Group for the Spoke Peer Review), Network Clinical Director, Network Manager, Network Performance Information and Research Manager, Rehabilitation Consultant, Therapy Manager, Nurse Ward Manager The Peer Review Inspection Team analysed and triangulated a variety of assessment sources including: Evidence File Reflective Practice Self Assessment and Presentation A Tour of the Unit, including talks with staff and patients Following the visits a report and recommendations were provided to each team. Action Plans/Progress Reports were developed in response to the recommendations, including dissemination of good practice within the team/ Trust and wider NHS. The Network Operational Committee and Strategic Board review implementation of recommendations as an additional assurance measure. The peer review programme has enabled the Network to take a more co-ordinated, collaborative and proactive approach to continuous service improvements. Issues relating to implementation of certain recommendations have been identified and are being addressed. Gaps in service standards were identified for elements of the workforce, as well as education and training, audit, research and innovation. Comments from staff included: The peer review was helpful for us as a unit team to review our services to support continuous improvement and quality care ; What is less easily measureable but was so apparent to the peer reviewers was the very positive culture in each unit, with staff so evidently enthusiastic about the service they offered to patients and the improvements already and planned for the future. The next steps are already underway to update the programme to include visits to all inpatient hub, spoke and extended units and community services throughout the Network. Service specifications standards have recently been reviewed collaboratively between network commissioners and providers and will be reflected in updated evidence files. The opportunity for an external peer reviewer is being explored. Ways of enhancing patient and family feedback are also being explored to ensure that their experience is given appropriate priority. An evaluation exercise is also planned to fully assess the impact of the programme and how it impacts on collaborative working and deliver of quality care. Angela Harrison, Performance Information and Research Manager angela.harrison@thewaltoncentre.nhs.uk Alison Price, Rehabilitation Network Manager alison.price@thewaltoncentre.nhs.uk

38 Quality Care Vitamin D Status and Its Effect on Functional Outcome Spoke Specialist Rehabilitation Units Phoenix Centre (Broadgreen Hospital) and Seddon Suite (St Helens Hospital) The aim of this project was to establish if a link exists between Vitamin D (25(OH)D ) levels and patients ability to progress during their rehabilitation stay using standardised functional outcome measures as assessment. Vitamin D was checked in 102 patients on admission to the Spoke Rehabilitation Unit at the Phoenix Centre for Rehabilitation at Broadgreen and St Helen s Seddon Suite. These patients had FIM/FAM outcome measures recorded (Functional Independence Measure/ Functional Assessment Measure) on admission and discharge and these were compared to their Vitamin D levels. Length of stay and age were also compared. Seventy five patients had Vitamin D levels of <50nmol/l (inadequate), with 45 patients having levels <30nmol/l (deficient). Higher Vitamin D concentrations were associated with improved changes in FIM/FAM scores (P=0.031). No significant difference was seen in length of stay or age (p=0.364 and p=0.436 respectively). Correlation between Vitamin D, 25(OH)D and functional outcomes is small but interesting. More research may clarify what impact supplementation of Vitamin D has on functional outcomes. Vitamin D levels will continue to be checked as part of the routine bloods for new admissions at Seddon Suite and The Phoenix Centre Spoke Rehabilittaion Units. Patient information is being developed to provide to the patients about Vitamin D. The study has been accepted at two international rehabilitation conferences and will be submitted for journal publication. Joanne Sim, Lead Dietitian Seddon Suite joanne.sim@sthk.nhs.uk Rachel Taylor, Lead Dietitian Phoenix Centre rachel.taylor@rlbuht.nhs.uk

39 Quality Care Cheshire and Merseyside Rehabilitation Network Educational Programme Network-wide: Specialist Rehabilitation Hub, (The Walton Centre) Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) and Extended (Partnerships In Care) Units and Community Services (Bridgewater, Mersey Care, The Walton Centre) To develop a bespoke Educational Programme for all disciplines and grades of staff through a consistent and co-ordinated approach, providing education and training in the care of patients with complex specialised rehabilitation needs. During a workshop in 2013, staff identified 6 core training sessions that would form the basis of the Pilot Education Programme for 2014/2015, including: Introduction to Rehabilitation Communication The Effects of Trauma on Nutrition Cognition Challenging Behaviours Physical Management Staff from appropriate disciplines from across the Network formed working groups to develop the content and format of the modules. The modules were delivered and were open to all staff working across the Network pathway (graduates, Band 4 and above). In total 65 staff attended. The modules were evaluated positively with staff who developed the content and delivered the sessions, with delegates and staff working across the pathway. The content will be included in the future training module. Staff identified the need for development of additional content to address gaps in training (e.g. the psychological impact of management of patients following traumatic injury or illness; Support and care of family/carers and managing their expectations; and vocational rehabilitation) Initial meetings have been held with local universities to explore the feasibility for development of an accredited specialist rehabilitation training module. Discussions are underway to develop a collaborative partnership between the Network and academia to support CPD accreditation and delivery of accredited training module for specialist rehabilitation. A Network Education Group has been established to support review, development, delivery and evaluation from 2016/2017. Sarah Flynn, Matron sarah.flynn@thewaltoncentre.nhs.uk Angela Harrison, Performance Information and Research Manager angela.harrison@thewaltoncentre.nhs.uk Alison Price, Rehabilitation Network Manager alison.price@thewaltoncentre.nhs.uk

40 Quality Care Improving Knowledge of Mental Health Problems in the Context of Brain Injury. Network wide: Specialist Rehabilitation Hub (The Walton Centre) Spoke (St Helens and Broadgreen Hospitals), Units Acquired brain injury is associated with mental health problems. Psychiatric problems after a brain injury are frequently under recognised and are associated with poorer outcome. Management of problems associated with mood, anxiety, behaviour and cognitive problems are challenging for staff- particularly newly qualified staff or staff with limited training in mental health conditions. The neuropsychiatry service sought to improve knowledge of psychiatric conditions across the network and improve staff ability to identify potential problems and improve their knowledge of services to manage and mental health problems. Staff reported that the training was effective and that they felt more confident in the identification and management of patients with mental health conditions. Continue to regularly deliver the training programme and gain feedback from staff. Kevin Foy, Consultant Neuropsyhciatrist kevin.foy@thewaltoncentre.nhs.uk The Mental Health Liaison Nurse and Consultant Neuropsychiatrist provided regular education sessions in specific areas of mental health conditions and the Mental Capacity Act. These sessions took place within each Rehabilitation Unit to facilitate ease of access for rehabilitation staff to attend. Topics included: Behaviour Management of challenging behaviour Depression including medication and other therapies Psychosis including medication and other therapies Deprivation of Liberty and the use of the mental health act and mental capacity act. Special Observations: a practical guide to managing someone on 1:1 special observations. Self-harm and suicide awareness/management of risk

41 Quality Care Improving Knowledge of the Model of the Rehabilitation Pathway Nationally and Regionally Network wide: Specialist Rehabilitation Hub (The Walton Centre) and Spoke (St Helens and Broadgreen Hospitals) Units Services for rehabilitation, including those with neuropsychiatric conditions are nationally limited and patchy. The Cheshire and Merseyside Rehabilitation Network (CMRN) provides timely and integrated rehabilitation and neuropsychiatry intervention. We wanted to Improve awareness and knowledge of the CMRN model of care to share best practice with other regions to inform national developments of neuropsychiatry services within Brain Injury services. Presentations offered clinicians interested in developing services for Brain Injury a better understanding and benefits of a integrated model of care. Continue to raise awareness of the model, regionally and nationally. Kevin Foy, Consultant Neuropsyhciatrist kevin.foy@thewaltoncentre.nhs.uk Neuropsychiatry staff delivered presentations at regional and national meetings, including: Walton Centre Inaugural Brain Injury Rehabilitation Conference March Neurosupport Liverpool Brain Injury Awareness Day, May North West Division, Royal College of Psychiatry Summer Conference, May 2015, Manchester. Faculty of Neuropsychiatry Annual Meeting, London, September Headway North Wales Conference November British Neuropsychiatry Association Annual General Meeting, London, February 2016.

42 Quality Care Swallowing Guidelines Bedside Signs Redesign Spoke Seddon Specialist Rehabilitation Unit (St Helens Hospital) To ensure that information regarding patients diet and fluid recommendations are communicated clearly and consistently to all staff. To ensure that all staff understand the information presented on bedside signs in order to maintain patient safety. To involve staff in the decision making process regarding the way the information is presented. Designed 2 different layouts for the bedside signs. Used the same diet and fluid recommendations, presented on the two different signs. Surveyed 18 members of staff the range of staff required to access and understand diet and fluid recommendations (catering staff, nursing students, HCAs, nursing staff, therapy staff, medical staff). Staff were asked which sign they found clearest and easiest to take the information from. All staff reported that they found one particular style of sign easiest to understand and retrieve information from. All signs on the Unit were subsequently changed to the preferred layout and these will be used for all new patients in the future. The effectiveness of the bedside dysphagia signs will be reviewed every 6 months, asking staff and students to summarise the information to speech and language therapy staff. Any changes will be evaluated accordingly. Lisa Conlin, Speech and Language Therapist lisa.conlin@sthk.nhs.uk

43 Quality Care Capacity Development in Audit, Research and Innovation Network wide: Specialist Rehabilitation Hub (The Walton Centre), Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) and Extended (Partnerships In Care) Units and Community Services (Bridgewater and Mersey Care) We wanted to provide staff access to local training and develop their knowledge and skills to deliver effective audit, research and innovation. The purpose of the training was to embed evidence informed practice for continuous improvements to services and patient health outcomes. To do this we established a Capacity Development Programme in that was offered to all staff working across the hospital and community services. Staff training needs were identified across the network to support undertaking of audit, research and innovation activities. A bespoke Audit, Research and Innovation Capacity Development Programme for was produced, in collaboration with research, audit and academic leads in the Trust to support staff to undertake local training which would encourage and facilitate activities and foster a culture of evidence informed practice. The programme included delivery of a series of face to face training workshops which focused on applied skills: Critical Appraisal Clinical Audit (Theory) Training Literature Searching Writing for Publication Journal Impact Journal Club Each workshop lasted two/three hours and used a mix of practical group based activities, taught theory and application in an engaging way to help staff develop their knowledge and skills. The Programme provided training sessions to equip staff with a greater knowledge of undertaking and promoting audit, research and innovation activities. We worked in collaboration with the audit and research teams in the Trust and a Clinical Information Specialist from the local University to develop, deliver and evaluate the programme. Positive feedback received from staff has been of a consistently high standard. Their feedback indicated they particularly found the workshops interactive and valued being able to share the development of their knowledge and skills with other colleagues. Staff reported raised awareness, better understanding of audit, research and innovation techniques as well as a raised awareness of audit, research and innovation amongst their colleagues. Positive comments include: Very inspiring and I now have a plan to get started on publishing my work ; Good practical session with lots of tools to use and share with my colleagues. We received enquiries from other services within local Trusts asking to attend the workshops which were facilitated. An evaluation report on the Programme has been produced which will support the development and delivery of the annual programme. The Programme has enabled new and developing investigators in audit and research to develop a good knowledge base. The Network has developed a programme for 2016/17 in collaboration with Edge Hill University. Workshops include: Designing a Conference Poster, Social Media, Critical Appraisal, Journal Impact Assessment and Systematic Review. Angela Harrison, Performance Information and Research Manager angela.harrison@thewaltoncentre.nhs.uk

44 Working together Respect & Dignity Empowerment Compassion and Empathy To give the best possible care we should all try to anticipate and appreciate each others needs and feelings, whether they are physical or emotional. Whether we are a patient, family member, carer or staff member, we should try to put ourselves in each others shoes every day. Quality Care Compassion & Empathy Honesty & Trust

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46 Compassion & Empathy Cognitive Educational Group for Families and Carers of Patient s with Neurological Condition in Inpatient Rehabilitation Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre) The focus of our Cognitive Educational Group is on enabling people to live as independently as possible and to maximise opportunities for our patients and their families/carers to progress their rehabilitation journey through education and support. There are several topics which address specific cognitive processes, including: concentration and attention, memory, anxiety, anger and mood, perception, levels of awareness, cognitive fatigue, dyspraxia and executive functioning. A self-care for families topic was also developed to support families to acknowledge the emotional impact on themselves, and provide them with useful strategies to maintain emotional and physical wellbeing. At the end of each session a satisfaction questionnaire was completed and a focus group was also undertaken. The results were analysed using thematic analysis and overarching themes developed including: the process, practicalities, and support and outcome. Sub-themes included: peer support, rapport building with staff, and increased knowledge and containment. Feedback has provided the basis to further improve the continuing running of the group on the Hyper Acute Rehabilitation Unit and support roll out on the Complex Rehabilitation Unit. The Group was nominated for the Patient Experience Award within The Walton Centre s Annual Staff awards in 2014 and was featured in the Trusts patient magazine, Neuromatters. The Group has also been featured in the Occupational Therapy News and will be presented at the Cognitive Occupational Therapy conference in Inclusion/exclusion criterion was devised. Appropriate patients family/carers were invited to sessions with a written invitation for a specific topic given a week prior to the session. The group sessions were held weekly and facilitated by an Occupational Therapist and a Clinical Psychologist. Hour long sessions included a presentation, tips to support family members with specific cognitive impairments, a practical task to demonstrate the cognitive impairments a relative may be experiencing and discussion. Development of an information leaflet (approved by the Trusts Patient Information Service) to take away and build a bespoke family folder. Future ideas to develop the group include: having a previous patient/family member on the group as an expert by experience, review current topics, and introduce others such as challenging behaviour and liaison with The Speech and Language Therapy team to support cognitive and communicative impairments. There is also the potential to roll out the group in the Network Spoke Units and Community Services. Sinead Savory, Occupational Therapist sinead.savory@thewaltoncentre.nhs.uk Hilary Kelly, Occupational Therapist hilay.kelly@thewaltoncentre.nhs.uk Dr. Samantha Townsend Clinical Psychologist sam.townsend@merseycare.nhs.uk

47 Compassion & Empathy Pets As Therapy Clatterbridge Rehabilitation Centre Spoke Unit (Clatterbridge Hospital) To allow patients at the Clatterbridge Rehabilitation Centre who have sometimes had prolonged hospital stays access to Pets As Therapy. We were aware of research which shows the power of the human-animal bond, both physically and socially, and we wanted to gain these positive outcomes for patients within an inpatient rehabilitation setting. We were contacted by the Pets As Therapy (PAT) charity organisation. The services had been available at Arrowe Park Hospital using PAT dogs and cats on 2 occasions) In line with Trust Policy, PAT volunteers underwent DBS checks and Trust Induction prior to visiting the Unit. Arrangements were made for Pat Volunteers Jill and her border terrier Maisie, and Emma and her poodle -jack russell cross Branston to attend the Unit and visit patients. They attend the Unit every Monday and Tuesday afternoon, and check with the nurse in charge to identify which patients they are able to visit. The Unit and the PAT volunteers follow guidelines as set out in the Trust s Dogs and Working Dogs Visiting Policy. Pets as therapy dogs on the unit have been a wholly positive experience for patients, families and staff. The visits lift the mood of patients and they report looking forward to the next one. Visitors check the visiting days for the PAT dogs so they can be present as well. For patients that have pets at home that are not allowed to visit due to strict infection control rules within hospital settings, the PAT dog visits are the next best thing. They allow the quality of life benefits, joy, comfort and companionship that stroking a friendly animal can bring. Observationally the presence of the PAT dogs has been effective in reducing anxiety and de-escalating patients who can at times demonstrate challenging behaviour. Comments from patients: I really look forward to the visits Being fussed is therapeutic for the dog and for me! Comments from families: It s nice to see something different being offered to my relative The dogs give reassurance and companionship, albeit for a very short period Comments from staff: It s nice to facilitate a service that provide enjoyment to the patients It s a good tonic for these patients who miss their own pets The PAT volunteers and dogs provide a comfort to those patients who do not have many visitors, if any at all To further involve Branston and Maisie into rehabilitation sessions to promote and progress therapeutic goals for patients during their rehabilitation journey. Mark Dillon, Ward Manager mark.dillon@nhs.uk

48 Compassion & Empathy Team Reflection and Learning on Service Users with Significant Behavioural or Mental Health Issues: Neuropsychiatry Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre ) Service users with rehabilitation needs seen within the inpatient pathway are by definition complex with both physical, cognitive, behavioural, psychological and social challenges. These factors can be particularly challenging for staff within the interdisciplinary team, particularly more junior staff and staff with less training in mental health. With this in mind, the neuropsychiatry service has facilitated reflective sessions on more complex and challenging clients seen in the rehabilitation units to: Facilitate staff learning from clients with challenging behavioural problems and mental health issues. Offer an opportunity for staff to reflect on how they coped personally and professionally with challenging cases. Establish a forum for therapists, medical professionals and staff to ventilate their feelings after challenging cases. In the selected cases that these sessions were used for it was possible to reflect objectively on the complexity of the cases and the difficulties in managing such situations combined with reflecting that staff had managed well in such difficult situations. Staff who attended the sessions were able to admit that they found the sessions useful, challenging and provocative. Explore opportunity to introduce Schwartz Rounds into the Rehabilitation Network Kevin Foy, Consultant Neuropsyhciatrist kevin.foy@thewaltoncentre.nhs.uk The neuropsychiatry service convened reflected learning sessions for a number of selected difficult and challenging cases where a patient/service user and their family had significant behavioural or psychiatric difficulties on a rehabilitation unit with resultant difficulties for staff. The sessions took place a while after the individuals were discharged from the units and we invited any staff members connected with their care to attend the session. During the session, we allowed the team to discuss the admission and reflect on the challenges, what the staff did well and what staff learnt.

49 Compassion & Empathy Values in Practice Network wide: Specialist Rehabilitation Hub (The Walton Centre) Spokes (St Helens, Broadgreen and Clatterbridge Hospitals,) and Extended (Partnerships in Care) Units and Community Services (Bridgewater and Merseys Care, The Walton Centre) To produce a set of Network values, complementary to each partner organisations values, to define what is important in the way we deliver specialist rehabilitation across our hospital and community services. Our values, embedded in our everyday working lives, will set out how we will work, regardless of the role we hold or setting, and support delivery of high quality, safe care to patients in the right place, at the right time and by the right team to maximise outcomes. A series of workshops were held with staff working across the hospital and community services to identify and develop values which were important to them, place the focus on our patients and will help us to achieve our vision and strategic principles. All staff were expected to embed these values in their day-to-day role. Staff were asked to discuss what is important in the way we deliver specialist rehabilitation to patients and their families and what a set of draft values meant to them. Staff refined the behaviours expected of all staff to align them with the values. Our Behaviours was set out to explain what staff are expected to do and not to do. After the session, all responses were analysed and a survey was circulated to all Network staff on the draft core values and their definitions and the set of behaviours. A follow up workshop looked at how we communicate and embed the new values and behaviours into daily practice. We created a set of core values that the whole Network can own and articulate and to help build an identity. These values are: Working together for patients; Respect and Dignity; Empowerment; Commitment to Quality of Care; Compassion and Empathy; and Honesty and Trust These values represent the strongest themes that emerged from staff engagement and consultation and were endorsed by the Network Strategic Board. Comments from staff include Our values and behaviours focus on delivery of compassionate care. We used a range of communication methods to embed the values, including: Development of values posters; Introduction of a celebratory awards scheme for staff who demonstrate the Network s values within their roles; Creation of a recognisable logo to be used in all communications. The Network acknowledges that embedding the values will be an ongoing process and have identified a number of actions to build on this: Values Workshops - a series of workshops that will include the values at the heart of that learning. Awards: embed our values more fully in the awards scheme for 2016/2017. Feedback from staff and patients - staff awareness of the values and how we demonstrate these in our roles. We will also focus on the patient experience and how this may be improved further. Recruitment, Induction and Appraisals - incorporate the values into all of its inductions, education programme, recruitment processes and identify how they could form a core part of the appraisal process helping shape individual objectives. Alison Price, CMRN Manager alison.price@thewaltoncentre.nhs.uk Angela Harrison, CMRN Performance Information and Research Manager angela.harrison@thewaltoncentre.nhs.uk

50 Working together Respect & Dignity Empowerment Honesty and Trust We should be honest and open in all communication and aspects of our service delivery with staff, patients and families/carers. Transparency can build trust that will facilitate a rehabilitation journey with positive outcome and experiences for patients and their families/carers. Quality Care Compassion & Empathy Honesty & Trust

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52 Honesty & Trust Improving Timely Discharges and Patient and Family Experience Through the Introduction of a Discharge Coordinator CMRN Rehabilitation Co-ordination Service to the Specialist Rehabilitation Hub (The Walton Centre) and Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) Units To support and facilitate timely and safe discharges of patients from the in-patient Network Hub and Spoke Rehabilitation Units to an appropriate setting, who in the absence of this role were experiencing an increased length of stay and delay in their discharge. This role needed to be able to work closely with all members of the Inter-Disciplinary Team (IDT) to identify support required on discharge and reasons for delay. The Discharge Co-ordinator role was introduced as part of the six IDTs across the Network. This has involved identifying complex discharges early and facilitating appropriate support to manage these issues and reduce delay. Work closely with all IDTs, attending meetings within the Hub, Spoke and Extended Specialist Rehabilitation Units to facilitate a smooth transition from hospital to home. Provide support and guidance to the IDT in being a key link with other health and social care professionals e.g. Social Services, Community Services and Commissioners. Facilitation of discharge planning meetings and development of an electronic referral form to identify and support the review complex discharges. Attend IDT teams external to the Network to support timely discharges and attendance at the Merseyside Hospital Discharge Network to gain valuable insight and share areas of good practice and also areas for improvement. By introducing the role of the Discharge Co-ordinator early findings show a positive effect as complex discharges are identified earlier which enhances the patient and family experience. Additionally, the role compliments that of the Rehabilitation Coordinator allowing more time for efficiency and effectiveness. Frees up clinical time for other members of the IDT and proactively assists in the reduction of length of stay and optimise the flow of patients across the Network. Undertake an audit to analyse and report delayed discharges throughout the pathway before and after the implementation of the Discharge Co-ordinator role. Identify barriers, gaps or delays in the discharge planning process and work to resolve these ensuring a smooth and timely transition. Build up relationships with Commissioning Bodies and other external agencies. Working together with the Merseyside Hospital Discharge Network to help share best practice and taking joint action to improve hospital discharges across Merseyside. Embed and evolve the role over time to meet the changing needs of the patient group. Gaynor Seiga, Discharge Coordinator gaynor.seiga@thewaltoncentre.nhs.uk

53 Honesty & Trust Single Point of Contact (SPOC): the right patient, at the right place at the right time Rehabilitation Co-ordination Service to the Specialist Rehabilitation Hub (The Walton Centre) Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) and Extended (Partnerships in Care) Units The CMRN wanted to offer a coordinated approach to rehabilitation services. From point of referral by acute services to assessment and admission to the CMRN continuing through to discharge from our pathway. The CMRN created the Rehabilitation Co-ordination Service to act as the Single Point of Contact for all referrals to our specialist rehabilitation services. The Single Point of Contact reviews all referred patients, to determine the most suitable pathway to meet the individual s rehabilitation needs. This may be within CMRN or signposting to the most relevant service to meet the patient s rehabilitation requirements. Timely and coordinated transfer of care from acute services into the appropriate rehabilitation setting. Bringing a coordinated approach to the rehabilitation process has allowed the CMRN to maximise patients outcomes by offering a varying degree of rehabilitation, based solely on the needs of the individual. The SPOC is a developing role which will continue to offer support to Multi-Disciplinary Teams across the Cheshire and Merseyside area ensuring that all patients with rehabilitation requirements are referred to the most appropriate services. The SPOC role is also developing a comprehensive database of CMRN activity which will allow for audit, research and innovation in order to further maximise our service, allowing for a more efficient throughput resulting in greater accessibility for all eligible patients. Paul Buckley, Single Point of Contact paul.buckley@thewaltoncentre.nhs.uk

54 Honesty & Trust Rehabilitation Coordinators Network wide: Specialist Rehabilitation Hub (The Walton centre), Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) and Extended (Partnerships In Care) Inpatient Units and Community Services (Bridgewater, Mersey Care, The Walton Centre) The Cheshire and Merseyside Rehabilitation Network (CMRN) wanted to offer a coordinated approach to rehabilitation services. They introduced the role of the Rehabilitation Coordinator to address the multifaceted needs of complex rehabilitation patients and their families and to support the Interdisciplinary Team to provide the most efficient and effective clinical service. The Rehabilitation Coordinator role was introduced as part of the Rehabilitation Interdisciplinary Team (IDT) at each inpatient rehabilitation unit within the CMRN. Link with the Single Point of Contact and bed management team to facilitate planned admissions to the rehabilitation unit and pathway transfers within the CMRN. Work within the Interdisciplinary team to facilitate team meetings, follow up action plans, ensure definite plans made for the patient s expected rehab pathway and work closely with health and social care professionals around complex discharge planning Meet regularly with patients and family members to support communication from the IDT, address concerns, manage any barriers and prepare patients and families for the long-term rehabilitation process which may extend far beyond hospital discharge. Engage with Rehabilitation Consultants for weekly discussion about referrals and pathway transfers. Also meet for ward rounds and family meetings as appropriate. Established links with the Major Trauma Network to identify early referrals and offer signposting to alternative rehabilitation pathways when that may be appropriate. As a unique and newly developed role, the Rehabilitation Coordinator has been invaluable to the development and success of the Rehabilitation Pathway. The role quickly evolved from the title of Key Worker to Rehabilitation Coordinator to better describe the varied tasks required to support the individualized needs of a caseload of highly complex rehabilitation patients. The role has continued to evolve and has played a key part in ensuring a partnership approach between patients, families, carers, and professionals. The role has now been fully embedded within the IDT of each inpatient rehabilitation unit. 100% of patients within the CMRN have been supported by a named Rehabilitation Coordinator from admission through to discharge. Having a coordinator on each unit allows a link between each step of the pathway, allowing a seamless transition for patients and families through the rehabilitation journey. Feedback from patients, families and the IDT has been positive. Patients and their carers/family report feeling that they have been supported through their rehabilitation stay. Team members express the Rehabilitation Coordinators are the glue that holds it all together.

55 Allowed an increased flow of patients through the rehabilitation pathway, highlighting patients ready for transition to the next level of care and working efficiently to start discharge planning processes in a timely manner. Contributed to accurate data collection to show appropriateness of clinical interruptions, length of stay, and timeliness of referral to assessment/ assessment to admission. Progress to provide Rehabilitation Coordinator role within Extended Rehabilitation and Community Team Locality 2 Establish better links with Clinical Commissioning Groups (CCGs) and Acquired Brain Injury (ABI) Teams Pilot role of Rehabilitation Coordinator in clinic outreach service Participate in CMRN Audit, Research and Innovation Projects Julie Gibbons, Team Leader Rehabilitation Coordination Service julie.gibbons@thewaltoncentre.nhs.uk

56 Honesty & Trust Embedding Patient and Staff Experience into Network Culture Network wide: Specialist Rehabilitation Hub (The Walton Centre), Spokes (St Helens, Broadgreen and Clatterbridge Hospitals) and Extended (Partnerships In Care) Units and Community Services (Bridgewater and Mersey Care, The Walton Centre) We wanted to gather experiences from patients and staff through the use of short films to bring to life the successes and range of benefits from specialist rehabilitation care. Patients who use the specialist rehabilitation services have a range of rehabilitation needs and we wanted to use an approach that involves them in capturing their journey and where other people could view their recovery to demonstrate the positive steps forward that people who use our services are taking. We interviewed 12 patients who had experienced an inpatient stay in one of our specialist rehabilitation hub, spoke or extended rehabilitation units. Each service is supported by a specialist rehabilitation inter-disciplinary team and we wanted to capture staffs experiences working in the service and network. We interviewed 12 staff working in the inpatient units, including medical, nursing, occupational therapy, physiotherapy, dietetics, speech and language therapy, psychology and rehabilitation co -ordination. Short edited films were created from the patient and staff interviews. The staff films have helped to improve understanding of roles and responsibilities within the inter-disciplinary team. Some family members also shared their experiences on film and spoke about supporting their loved one through specialist rehabilitation following a traumatic injury or illness and copy with its effects. The films were shown to staff at a pop up cinema, conveying in an impactful way how patients and staff experience the service. The patient films were screened at a local cinema to members of the public, patients, staff and commissioners. Films have been watched at Network Strategic Board meetings, at Trust Quality Meetings and at Trust Open Days.

57 A further promotion of the films is planned to maximise the impact, using the staff and patient films to connect with our values, and to incorporate these into staff inductions and training and education programmes. Alison Price, CMRN Manager Angela Harrison, CMRN Performance, Information and Research Manager Priorities for next year include patient involvement and enabling staff to deliver safe, effective and person -centered compassionate care. This will be driven by front-line staff, working alongside patients and their families/carers to improve experiences. We will explore opportunities for experience-based co-design ; bringing together staff and patients to explore the findings and work in small groups to identify and implement activities that will improve the service and the care pathway (e.g. processes, communication). The Network is planning to develop a portfolio of patient and staff case studies and experience films aligned to Network objectives to ensure wider impact, which is supported as a Board priority. The original project focused on patients undergoing inpatient rehabilitation and staff involved at this stage of the pathway. Ways of enhancing patient, family/ carer and staff experience are being explored, including community experience, to ensure that experience based co-design is given the appropriate priority. Information and support resources are widely aimed at patients themselves and we are looing at the potential to develop a family and carers support package using the films. An evaluation exercise is also planned to fully assess the impact of the films.

58 Notes

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60 Map of our services Our Partners We would like to acknowledge Cheshire Wirral Partnership for the idea of a Book of Best Practice.