Quality Network for Eating Disorders (QED) 1st National Report. Editors: Kiana Azmoodeh, Mark Beavon, Harriet Clarke. July 2016 Pub. No.

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1 Quality Network for Eating Disorders (QED) 1st National Report Editors: Kiana Azmoodeh, Mark Beavon, Harriet Clarke July 2016 Pub. No. CCQI 1236

2 Contents Foreword 3 Introduction 4 History of QED 4 QED Process 4 Membership 6 Status 6 Contextual Data 7 Opportunities for Members 9 Themes and Recommendations 10 Information 10 Carer Involvement and Support 11 Admission Process 12 Safety 12 Catering 13 Therapeutic Programme 13 Feedback 15 Peer Review Teams 15 Peer-Revew Booklet 15 Standards 16 What's Next? 18 QED Forum 18 Standards Revision 18 Peer-Reviewer Training 18 Special Interest Days 18 Appendices 19

3 Foreword The first quality improvement audit cycle for adult eating disorder inpatient services is now complete, with 25 of 32 services accredited thus far, 12 with excellence. It is time to take stock of achievements and the learning in readiness for standards revisions and further development of the Quality Network for Eating Disorders (QED). It is clear from the data that adult inpatient services vary enormously in size (five to 20 beds) and average length of stay (28 to 302 days), suggesting significant diversity in clinical ethos and approach. With little evidence base to guide inpatient treatment for eating disorders, how do we know which approaches represent the best quality? Service users, carers and reviewers tell us that there is much that we do well There are also helpful pointers in the data about what we could do better: information for carers, preparation for admission, reliability of group programmes and ensuring breaks for staff appearing to be important themes. Carers report a common theme of difficulty across transition from child and adolescent (CAMHS) to adult services. This is a perhaps a timely reminder that QED began life in 2009 as a multi-disciplinary quality initiative encompassing all eating Disorder services, across service settings (inpatient to community) and across the lifespan. CAMHS QED standards are embedded in QNIC (Quality Network for Inpatient CAMHS) and now also QNCC (Quality Network for Community CAMHS). Some creative reintegration of the QED network will be needed in order that, together, we can begin to address the crucial quality issues arising at transition between inpatient and community settings, and between CAMHS and adult services. Dr Frances Connan Consultant Psychiatrist and QED Advisory Group Chair 3

4 Introduction History of QED The Quality Network for Eating Disorders (QED) is a quality improvement initiative managed by the Royal College of Psychiatrists Centre for Quality Improvement (CCQI). The network was developed in order to improve the standard of care provided by eating disorder services throughout the United Kingdom, and to enable the sharing of practise on a national level. QED achieves this by: Accreditation and peer review of eating disorder services; Creating a national network to support staff through: - an updated database of standards for adult inpatient care; - the QED peer-review process; - an discussion group; - events. The first proposal meeting for QED was held in March 2009, with development/steering group meetings taking place between June 2010 and February It was during this time that the structure of the network was established; the Pilot Standards - against which wards would be assessed -were developed and subsequently published in April These focus specifically on adult inpatient eating disorder services, which is one quadrant of QED. Nine adult inpatient eating disorder services completed the Pilot Phase of QED, following which the standards were revised and the First Edition of Adult Inpatient Eating Disorder Standards were published in November From June 2014 onwards, there was a national rollout of network membership, with 32 adult inpatient eating disorder wards now participating members of QED. The nine member wards from the Pilot Phase are currently undertaking their second Cycle of QED accreditation. QED Process The First Edition of standards was drawn from a range of authoritative sources, and incorporates feedback from service user and carer representatives, pilot studies and experts from a MDT range of relevant professionals. They are comprehensive with some aspirational standards; it is unlikely that any ward could meet all of them. To support their use in the accreditation process, each standard is categorised as follows: Type 1: failure to meet these standards would result in a significant threat to patient safety, rights or dignity and/or would breach the law; Type 2: standards that an accredited ward would be expected to meet; Type 3: standards that an excellent ward should meet or standards that are not the direct responsibility of the ward. Page 02 4

5 There are three main phases of the QED accreditation process: self-review, a peerreview visit, and a decision about accreditation status. An accreditation Cycle lasts 3 years, with an interim self-review after 18 months of accreditation. A ward s accreditation may be deferred for up to a year whilst improvements are made to address any unmet Type 1 standards highlighted by the self-/peer-review. Figure 1 demonstrates the complete QED cycle: Figure 1: The QED review cycle; including standards development, self- and peer-review, accreditation and members forum. Accreditation Categories: Accredited as Excellent (discontinued December 2015): - Wards meeting 100% Type 1 Standards, >95% Type 2 standards & a number of Type 3s. Accredited: - Wards meeting 100% Type 1 Standards, >80% Type 2 Standards & a number of Type 3s. Deferred: - Wards not meeting one or more Type 1 Standard, or <80% Type 1 Standards, but demonstrating the capacity to meet these within a period of time. Not Accredited: - Wards not meeting one or more Type 1 Standard, or <80% Type 1 Standards, but NOT demonstrating the capacity to meet these within a period of time. Following the assessment of all 32 member members against the First Edition of Standards, the QED Cycle will begin again. For further information on the QED standards and processes, please contact the QED Project Team. Page 02 5

6 Membership Status 32 adult inpatient eating disorder services within the UK are members of QED; 30 in England and 2 in Scotland (please see Appendix 1 for details). In February 2016, accreditation status was as follows: 12 Accredited as Excellent 13 Accredited 4 Deferred 3 In Review Stage There are 32 specialist adult inpatient eating disorder wards in England, meaning that 100% of eligible wards participate in QED. We estimate that there are 4 in Scotland (50% participation), 0 in Wales and 0 in Northern Ireland. Any updates to membership and accreditation status can be found on the QED website. Figure 2: Location and accreditation status of QED member wards (Feb. 2016). Page 02 6

7 Contextual Data The following figures are based on data collated from all 32 member wards. Number of beds: Occupancy: Number of Beds Occupancy (%) 100% 90% 80% 70% 60% 50% 93% 60% 100% 0 Mean Minimum Maximum 40% Mean Minimum Maximum Average Length of Stay: Average Length of Stay (days) Mean Minimum Maximum Figures 3, 4 & 5: Wards are asked to submit a range of contextual data upon joining QED: number of beds; occupancy; average length of stay. Details of the staffing complement are also submitted (Figure 6). Staffing: Figure 6 details the mean Whole Time Equivalent (WTE) of each staff profession per 10 beds WTE per 10 beds Figure 6 WTE was used in place of staff numbers to best represent input into the ward; for data regarding staff numbers, please see Appendix 2. Page 02 7

8 Staffing levels: As seen in Figure 7, a moderate positive correlation is shown between number of beds and WTE for RMNS (.55) and nursing assistants (.50). As expected, the same is true for all ward staff (0.63) (see Appendix 3). WTE Number of Beds Nursing Assistants Reg.Nurse Linear (Nursing Assistants) Linear (Reg.Nurse) Figure 7: The relationship between number of beds and WTE of the nursing establishment. The nursing staffing levels per shift, across the membership, are as follows: 7 Number of staff per shift Early Late Night Early Late Night Qualified Unqualified Minimum Maximum Mean Figure 8: Number of qualified and unqualified staff across early, late and night shifts. Future Cycles of QED will continue to ask for contextual data, allowing for comparisons to be drawn across time. This will provide a useful insight into the changing picture of adult inpatient eating disorder services. NB: Data from one member service been excluded from all contextual data figures; for the purposes of QED processes, two neighbouring wards within one service submitted combined data. Page 02 8

9 Attending peer-review visits Opportunities for Members Staff, service users and carers from QED member teams have to opportunity to train with the CCQI to attend peer-review visits to other adult inpatient eating disorder services. Reviews serve as part of the accreditation process, with an emphasis on sharing ideas regarding quality and best practice. Peer reviewers are able to observe and discuss the structure, processes and function of other teams, as well as the varying therapeutic approaches. Previous peer-reviews have seen reviewers making useful contacts and remaining in touch, enabling on-going discussion and reducing clinical isolation. The peer-review process would not be possible without trained QED reviewers volunteering their time to visit member wards, and the QED project team would like to thank all of the professionals, service user and carer representatives whose hard work and enthusiasm has allowed to network to develop. QED discussion group: All staff from QED member services are eligible to join the QED discussion group, which connects members via a moderated forum. Queries regarding practice, service development, quality improvement and the QED standards/process are directed to this central address, and distributed to the rest of the group; currently there are 136 members. Responses are collated and redistributed, to ensure that the whole group can benefit from the sharing of information. Recent discussion topics include ward s nursing establishment, environment development and catering feedback. To join the QED discussion group please Join to QED@rcpsych.ac.uk. Events: The network is now hosting annual QED Forums with the first being held in May This conference was exclusively for staff working in eating disorder services and service users and carers with experience of these services. The cost of attendance was covered by member wards subscription fee; thus staff from member wards were entitled to attend for free, with non-members paying a small fee. There were keynote speakers, presentations and workshops covering a range of topics; from important quality issues in eating disorder services, to the relationship between inpatient and community settings. For more details please contact the QED Project Team. Page 02 9

10 Themes and Recommendations All 32 member wards of QED have now been assessed against the same set of standards (Standards for Adult Inpatient Eating Disorder Services 1st Edition). By collating the self-review data of all wards, we have been able to observe and extract themes, highlighting common areas of achievement and areas requiring improvement. Often the peer-review visit reveals useful additional information which had not been previously captured by the self-review data; emergent themes from peer-review reports have therefore also been included. The percentages detailed below reflect aggregate data from across the membership. Suggested actions have been drawn from those made by review teams, the QED Accreditation Committee and by observations of good practice highlighted by peer-reviewers - of member wards. Theme 1: Information Areas of Achievement Across the membership, patients reported a good provision of information specific to eating disorders. Of 316 patient questionnaire responses, 75% confirmed that education and information on the nature, course and treatment of eating disorders was given (Standard 44.8[2]). 73% of 311 patients reported having been offered information and harm minimisation advice about the short- and long-term risks to health associated with eating disorders (44.9[2]). Comments provided by patients at self- and peer-review explained that this education forms an integral part of recovery, and that whilst this may not be provided at the point of admission, it is delivered through the wards group programmes once attended. 78% of 326 patient responses stated that a I feel I continuously am given information about the effects of my eating disorder, on my health. welcome pack had been provided, which was found to comprehensively cover a range of specific criteria (U18.5[1]) across the 32 member wards. 100% of 32 wards provided a welcome pack, with 99% adhering to the standard s full 11 point criteria; including a description of the ward/unit and its ethos, the current programme of treatment, rights and responsibilities, the staff team, visiting arrangements, personal safety, and practical needs. Areas for Improvement Whilst it was observed that there is a good provision of information contained in welcome packs, leaflets, notice boards patient responses indicate that this is not necessarily always received or retained. Of 320 patient responses, reportedly only 51% had been told No one went through it with me. how to make a complaint, 53% given information on advocacy, 25% informed on how to access their records and 62% given written information on their rights (either as a detained or informal patient). Peer-review reports revealed that much of this information is available; captured in welcome packs and/or embedded on the admission checklist. However, it is evident that this is not always either clear or retained. Page 02 Education has been fundamental to my recovery. Psychoeducation is fantastic. The patient guide given was too detailed/too much writing. 10

11 QED Suggests: Following discussions with patients and staff at peer-reviews, the full, comprehensive welcome pack may be overwhelming and neither read nor retained during the early stage of admission. QED recommends that a snapshot of key information, e.g. a user-friendly hand-out, is given on admission, with a dedicated key worker session arranged to go through the welcome pack information in greater detail. This process could form part of the admission checklist to ensure patients routinely receive this provision. Theme 2: Carer Involvement and Support Areas of Achievement Of the 32 member wards, 29/32 (91%) had a designated carer lead dedicated to carer support (22.17[2]). 172 carer questionnaire responses revealed that 66% of carers had been given We felt listened to, support and all aspects of care were explained. We never feel a nuisance everyone always had time. information on support groups for carers of people with eating disorders. 73% of 175 carers felt that reviews were facilitated to allow them to contribute and express their views (24.10[2]). Areas for Improvement Only 37% of 176 carers had been advised how to obtain an assessment of their own needs (22.3[2]) with 87% of staff stating that this provision is available and only 46% of 171 carers were offered information regarding carer advocacy. A carer s introduction pack/information on admission would have covered much of this [information]. Regarding eating disorder-specific education and information, including the nature, course, treatment and short-/long-term risks to health (44.8[2]/44.9[2]), only 47% of 167 carer respondents had been offered this. Conversations with carers at peer-review revealed a common theme of difficulty with the transition from CAMHS to adult services, with regard to involvement and information (often due to lack of consent), and a lack of support in bridging this transition. QED Suggests The provision of information for carers and perceived support was a consistent area for improvement throughout the network. QED suggests that member wards develop and distribute separate carer information packs, with a separate carer s information board clearly displaying the details of the ward s designated carers support lead. Given the reported difficulties in transition between CAMHS and adult services, carer information packs could include details on changes, e.g. consent/ information sharing, and a clearly stated opportunity to speak with staff for support on this. Page 02 11

12 Theme 3: Admission Process Areas of Achievement 84% of 327 patients said that they felt welcomed by staff upon arrival on the ward, were shown to an appropriate area and were offered refreshments. Similarly, 83% of 319 patients were introduced to a member of staff who would be their point of contact for the first few hours of admission (U18.1[1]/U18.2[1]). Areas for Improvement Whilst 30/32 member wards reported inviting patients and families to visit the ward prior to admission (standard 16.11), less than 50% of patients (48% of 324) and carers (46% of 175) responded that this was the Wasn t told all the routine/what I was meant to do. case. It is, however, recognised that in cases of emergency/rushed admissions, this may not always be possible. Feedback from patients at both self- and peer- Could have been more helpful in review was often that the admission process is explaining how meals work. daunting and stressful, particularly when this is the first admission. Patients at times reported being unsure of what to expect, with specific reference to the first meal time(s). QED Suggests I was welcomed by two very friendly nurses who treated me with dignity and respect. I was incredibly scared and the whole team relieved some of that anxiety. Patients can be supported in easing the admission process by ensuring that robust preparation processes are in place, with guidance routinely provided regarding what is going to happen in the first few hours and the first few days, including the approach to meal-times and any practical considerations (e.g. being collected, or making one s own way) around this. Theme 4: Safety Areas of Achievement 85% of patients (from 319 responses) had been informed how to contact and/or return to the ward if any problems arose whilst on leave (15.3[1]). Self- and peer-review comments reveal that staff across the membership generally go above and beyond to provide support during leave, checking in with patients to ensure both their safety and well-being. Areas for Improvement Whilst welcome packs often contained information regarding the rules of the unit, only 69% of patients (320 respondents) felt that a mutual code of conduct outlining exceptions of how both patients and staff should behave was provided (U29.3[1]). I was told how patients should behave, but not how staff should behave. Only 79% of staff felt able to take regular allocated breaks away from patients during each shift (U6.12[1]). Page 02 We are not only given the information on how to contact the unit; they contact us to check in if we forget. 12

13 The reasons given for missed breaks commonly cite staff shortages, ward demands, incidents, ward culture and therapeutic mealtimes with patients often being perceived as a break. QED Suggests: For a code of conduct to reflect both patient and staff needs, a meeting can be held between patients and staff to formally develop mutual expectations. This can be displayed on the ward, clearly marked for both patients and staff, and contained within the welcome pack. Routine recording and monitoring of allocated breaks is suggested to improve this provision for ward staff. Sections can be added to shift planners to allocate breaks, with a tick box completed when this is taken. If breaks are missed, a comment and any subsequent action can be recorded. Regular audits can raise awareness to management if breaks are being routinely missed, and steps taken to improve this. Theme 6: Catering Areas of Achievement 77% of 308 patients responded that their food choices are respected (41.21[1]), and 86% of 313 respondents confirmed that their religious or ethical dietary restrictions were respected; of those whose were not, 61% stated that staff explained why (41.24[1]). Some member wards have worked closely with their dietitian(s) in order to accommodate a vegan diet. Areas for Improvement 55% of 312 patients reported that staff had not asked them for feedback about the food provided on the ward (41.17[1]), with only 35% of 313 patients having been asked about their views on the catering formally, e.g. by means of a survey/questionnaire (41.5[2]). Difficulties in acting on patient feedback have been highlighted by staff at peer-reviews, and have been a recent topic on the QED discussion forum. QED Suggests QED suggests that feedback on catering arrangements is sought through community meetings, a comments book and/or a more formal questionnaire, which can then be audited. Where possible, regular meetings can be held directly between the patient group and catering provider (e.g. where services have access to an onsite chef). Any changes should be disseminated to patients to communicate action, e.g. using a you said, we did format. Theme 7: Therapeutic Programme Areas of Achievement In weekly dietetics sessions I was able to make my own choices. All 32 member wards confirmed having a structured therapeutic programme from Monday to Friday, which is made available to patients; this was corroborated by 84% of 313 patients (53.28[1]). Timetables across the membership include a range of therapeutic models, including psychoeducation, psychological groups, occupational therapy groups and structured rest time, as confirmed by 98% of 797 staff respondents (53.30[2]). Page 02 13

14 The group activity programme is therapeutic, engaging and informative. 99% QED of 791 Membership staff verified that the content of the programme involved post-meal/snack support, group and individual sessions and leisure time (53.29[2]). 100% of 561 staff stated that self-care, work/study, leisure and life skills are addressed, and that independent living, communication, assertion and emotional coping are promoted (standard 53.27[1]). 97% of 797 staff confirmed the provision of post-meal/snack support, and 80% of 312 patients echoed this (41.20[1]). This was largely observed at peer-review to form part of wards structured therapeutic programmes, and is formally embedded into timetables. Areas of Improvement Comments from patients very often detailed that whilst the therapeutic programme is good, groups You could feel very alone, are frequently cancelled, or the full programme does anxious and struggle more with not run due to staff shortages and ward demands. your illness. You could be left At times, a lack of replacement or alternative activity feeling very low and let down. was cited as causing distress. Whilst 29/32 wards reported that patients have access to a specialised pharmacist/pharmacy technician to discuss medication, only 38% of 315 patients were aware of this. Similarly 28/32 wards stated that this provision is available for carers also, with only 17% of 172 carers aware of this. Maybe agencies could do more training with their staff on eating disorders? QED Suggests Both self- and peer-review feedback highlighted distinct difference in care and approach between permanent staff, and inexperienced bank/agency staff. Patients emphasised the negative effects of this with particular reference to therapeutic support at meal times, and unhelpful comments. Member wards should strive to, where possible, provide patients with as much advance warning as possible when a group is cancelled, and provide a reason. In these instances, a replacement or activity should be facilitated instead so that this does not become empty time, in addition to the already unstructured rest time on the ward. Access to pharmacy can be better accessed by becoming structured, such as incorporating a specific pharmacy clinic slot into the timetable. Patients can access this on either a drop-in basis, or on a rotational sessional basis. To reduce the negative experience of patients with agency staff, suitable training and knowledge should be ensured prior to allocating roles such as post-meal/snack support. Where possible, only permanent or experienced/known bank or agency staff should adopt these more critical therapeutic support roles. Wards can develop their own training packages, alongside patients, and provide a helpful hand-out of key dos and don ts. NB: Questions of the Patient and Carer Questionnaires are optional, and the staff questionnaire is routed, i.e. only certain staff professions will have been asked/required to respond to certain questions. These reflect the varying response rates for questions/standards. Page 02 14

15 Feedback From the onset, the QED Project Team have been keen to gather feedback from the membership regarding their experience of QED, in order to shape the network. Feedback has been gained on a number of areas, from the standards themselves to overall processes. Summarised below is an overview of the feedback we have received and actions which have been taken as a result. If you would like to provide feedback on QED at any time, please contact the Project Team. For details of general feedback collated from hosts and reviewers following peer-reviews, please see Appendix 4. Peer-Review Teams You said: Feedback from both peer-reviewers and host teams highlighted the need for exclusively specialist eating disorder professionals on review teams, with input from professionals from other mental health backgrounds often complicating the interpretation of standards and practice. Similarly, service user and carer representatives should have specific experience of eating disorders. We did: A recruitment drive and QED-specific training day was held in September 2014, to add to the pool of trained QED reviewers and boost the number of eating disorder specific professionals attending reviews. In a move to ensure that peerreview teams consist exclusively of eating disorder professionals, a member of the QED Project Team began attending all peer-reviews to accompany new reviewers and less experienced teams, rather than experienced reviewers from the wider Accreditation for Inpatient Mental Health Services (AIMS) project. This feedback and subsequent change has enabled a more valuable and relevant experience for both reviewers and host teams. Peer-Review Booklet Interpretation of the standards by different staff from different backgrounds needs some work. It is striking that someone from [another mental health background] sees things differently than someone from an ED background. You said: As a carer, I find the paperwork a little clumsy in some areas. There are carer/patient questions in other sections which can be easy to miss. Service user and carer representatives reported difficulty in ensuring that all standards relating to the patient and carer meetings were covered on the peerreview day. Due to the triangulation of data (i.e. asking similar questions of multiple sources for a specific standard), some questions relevant to patients and carers would be found, for example, within the Environment and Facilities Audit section of the peerreview booklet. We did: The QED Project Team created distinct sections for the both the patient and carer meetings. Standards triangulated with other data sources were duplicated in the peer-review booklet to ensure inclusion in both/all relevant sections, allowing the patient/carer sections to be read as a questionnaire script, with suggested opening and closing remarks to support the facilitation of the meetings. 15

16 Standards You said: Throughout Cycle 1 of QED, with wards reviewed against the 1st Edition of the standards, a number of standards were repeatedly discussed and debated at length with regard to interpretation and compliance. The following standards were identified as particularly eliciting disagreement amongst the membership: [1]: A formal assessment of nutritional status is carried out by a qualified dietitian on admission, within two working days [1]: Weighing is carried out regularly (no more than twice a week) and is documented [1]/53.12[1]: Social/recreational activities are provided at weekends/during the evenings. We did: As the network is continually developing, the QED Project Team emphasised the importance of responsiveness to the needs of members, and collated feedback from self-review data, peer-review team comments, and host team responses. The above standards (amongst others) were examined in light of this feedback by the project s Clinical Lead for Accreditation, and the QED Accreditation Committee, MDT professionals from member wards, and service user and carer representatives. A summary of the decisions made, and precedents set, by the Committee in March 2015, is outlined below: [1]: A formal assessment of nutritional status is carried out by a qualified dietitian on admission, within two working days. Of the 355 health records audited across the membership; 58 elicited a no response (83% yes ). For the most part, record-keeping across the membership demonstrates compliance with this standard. It was discussed that the requirements of this standard are clinically justified and should remain in place. Deviation from this process should therefore be by exception and not as protocol: e.g. for an emergency admission, the assessment should be carried out by an appropriately-trained member of the MDT, with a review by a dietitian within at least one week. All accredited wards have aligned their practice to ensure this provision is in place for patients across member wards [1]: Weighing is carried out regularly (no more than twice a week) and is documented. Of the 355 responses health records audited across the membership; 20 elicited a no response (94% yes ). At the point of data collection (self-review), member wards practice was shown to largely be in line with this standard. For wards with a protocol for daily weighing during the initial stages of admission, a precedent was set that this should again be by exception with clear medical justification rather than as a blanket protocol [1]/53.12[1]: Social/recreational activities are provided at weekends/during the evenings. Whilst collating ward reports, it became apparent to the QED Project Team that there was a lack of consistency between peer-review teams interpretations of these standards; whether they refer to some structured activities, or simply the provision of resources which can be accessed (DVDs, games, etc.). 16

17 When responding to their draft peer-review report, wards commonly reported that evenings and weekends are encouraged as downtime following the intensive 9-5 weekday programme. However, there was discussion over what this means for patients who are not accessing the full groups timetable and/or do not have leave. Furthermore, patient comments at self-/peer-review highlight patients requests for structure, guidance and support during these times. Due to the current lack of an evidence base, it was agreed that there should be some flexibility with regard to what is acceptable in order for these standards to be met. Accredited wards have since demonstrated that, at the very least, some loose structure is provided during evenings and weekends; patients are actively encouraged by staff to access the available resources; additional support is readily available in the form of suggestions for how to manage this unstructured time. An additional measure was taken by the QED Project Team to adapt the data collection tools, to better capture the nuances of this standard. The alterations, and before/after aggregate self-review data, are shown below: Pre-March 2015 (21 wards): Environment and Facilities Audit (21 responses) % Yes Social/recreational activities are provided during the evenings. 86% Social/recreational activities are provided at weekends. 86% Patient Questionnaire (200 responses) % Yes Are there social/recreational activities during the evening? 31% Are there social/recreational activities at weekends? 38% Post-March 2015 (11 wards): Environment and Facilities Audit (11 responses) % Yes Structured/timetabled social/recreational activities are provided at weekends. 91% Other activity resources are available to patients at weekends. 100% Structured/timetabled social/recreational activities are provided during the evenings. 82% Other activity resources are available to patients during the evenings. 100% Patient Questionnaire (114 responses) % Yes Are there structured/timetabled social/recreational activities at weekends? 25% What other activity resources are available for you to access at weekends? [comments] Are there structured/timetabled social/recreational activities during the evenings? 21% What other activity resources are available for you to access during the evenings? An additional question was developed, and asked of both staff and patients: [comments] Patient Questionnaire (116 responses) Do staff give you help, support or guidance to enable you to make the most of your evenings and weekends? Staff Questionnaire (248 responses) Do you give help, support, of guidance to patients to enable them to make the most of their evenings and weekends? % Yes 43% % Yes 99% 17

18 What s Next? QED Forum The first QED conference was held on Monday 9 th May The day was an exciting occasion bringing together professionals, service users and carers from across the membership of adult inpatient eating disorder services. Presentations and workshops focused on important quality issues in eating disorder services, as highlighted by member services. An update on QED was given and discussions held on where the network goes from here. The overarching objectives of the forum are to bring the membership together, highlight and discuss issues relevant to eating disorder services and facilitate an opportunity to shape and refine the network, with the aim for this to be an annual event. Standards Revision Following the QED Forum, feedback relating to the standards themselves will be collected from the membership ahead of a Standards Revision event. One representative from each member ward will be invited to join a Standards Revision working group, allowing for the needs and perspective of each ward with the demonstrated differences in practice and approach to be considered and incorporated. Peer-Reviewer Training The 2nd Edition of QED standards will be completed prior to the next cycle of QED Peer-Reviews, which will begin in June Ahead of these reviews, both new and existing reviewers will be invited to attend fresh and specific QED peerreviewer training, looking to improve the quality and value of the peer-review experience. Special Interest Days As the network progresses, the QED Project Team will be looking for ideas from the membership and the QED Advisory Group to develop Special Interest Day conferences, inviting the membership to attend events focusing on the discussion of areas pertinent to eating disorder practice. Development of the network As adult inpatient services are only a part of the QED network, the project will be looking at more integration with Child and Adolescent Eating Disorder Services over the coming year. This will also be alongside the development of Adult Community Eating Disorder standards and reviews. 18

19 Appendix 1 List of QED Members (February 2016) Independent Sector Cygnet Healthcare Newmarket House Clinic Priory Group The Retreat, York Riverdale Grange Eating Disorder Unit Cygnet Hospital Ealing Newmarket House Clinic Norwich Adult Eating Disorder Service Priory Hospital Bristol Adult Eating Disorder Service Priory Hospital Chelmsford Adult Eating Disorder Service Priory Hospital Glasgow Adult Eating Disorder Service Priory Hospital Hayes Grove Adult Eating Disorder Service Priory Hospital Roehampton Adult Eating Disorder Service Priory Hospital Southampton Russell House Cheadle Royal Hospital Sion Unit Priory Hospital Preston Woodbourne Priory Hospital Birmingham Naomi Ward The Retreat, York Riverdale Grange Sheffield England NHS Services Avon and Wiltshire Partnership Trust Barnet, Enfield and Haringey Mental Health NHS Trust Birmingham and Solihull Mental Health NHS Foundation Trust Cambridgeshire and Peterborough NHS Foundation Trust Central and North West London NHS Foundation Trust Cheshire and Wirral Partnership NHS Foundation Trust Devon Partnership NHS Trust Dorset HealthCare University NHS Foundation Trust Leeds and York Partnership NHS Foundation Trust Leicestershire Partnership NHS Trust STEPS Unit Southmead Hospital Phoenix Wing St. Ann s Hospital, Tottenham Cilantro Suite Edgbaston Ward S3 Addenbrookes Hospital Vincent Square Chelsea and Westminster Hospital Oaktrees The Wirral Haldon Centre Wonford House Hospital Kimmeridge Court St. Ann s Hospital Yorkshire Centre for Eating Disorders Newsam Centre Leicester Adult Eating Disorders Service Bennion Centre 19

20 NAViGO Health and Social Care CIC Northumberland, Tyne and Wear NHS Foundation Trust Oxford Health NHS Foundation Trust South London and Maudsley NHS Foundation Trust South Staffordshire and Shropshire Healthcare NHS Foundation Trust South West London and St. George s Mental Health NHS Trust Tees, Esk & Wear Valleys NHS Foundation Trust Rharian Fields Grimsby Ward 31A Royal Victoria Infirmary Cotswold House Marlborough Cotswold House Oxford Tyson West 2 Bethlem Royal Hospital The Kinver Centre St. Chad s House Avalon Ward Springfield Hospital Birch Ward West Park Hospital Scotland NHS Services NHS Lothian Regional Eating Disorder Unit St. John s Hospital 20

21 Appendix 2 Mean number of staff, by profession, across member wards: Appendix 3 The relationship between number of beds and the WTE of all ward staff, across the membership. 21

22 Appendix 2 Collated feedback from host and peer-review teams from between September 2014 and February Participants: 40 (34 Reviewers; 4 Host Teams) % "Very/ Mostly Useful" OR % "Yes" Documentation and guidance notes 98% Support from the QED Project Team 95% How useful was it to have the opportunity to meet people from another ward? 97% Do you feel that you got the most opportunity to discuss acute impatient care issues with your peers from another service? Do you feel that you had adequate time during the day? Were there any elements that you could not achieve during the day? E.G. Key staff unable to attend meetings, last minute changes to the timetable, problems disseminating information about the review to relevant parties. How useful was it to go through the peer review process? 90% 76% 26% 97% Do you think you learned anything new? 89% 22

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