Older Adult Mental Health Inpatient Services are paving the way to being a Centre of Excellence Three away days were arranged for the Older Adult Mental Health Inpatient Service at the Granary Hotel. All staff were invited to attend a day. The aim of the day was to celebrate our successes, for example, bibliotherapy group and to provide information on work being undertaken for example, AIMS and Safewards. Ten presentations were given over the course of the day. Each presentation consisted of a 5-10 minute presentation, followed by an opportunity for table discussion and concluded with feedback. Matt Stringer, Service Lead opens the day Matt Stringer, Service Lead opened the day by celebrating Older Adult Inpatient Service success with the latest CQC inspection. As a service, we received good for all 5 areas: safe, effective, caring, responsive and well-led. He fed back that the rest of the service were keen to know how Older Adults provided the level of care they did, whilst acknowledging they faced similar demands and challenges as other parts of the trust and organisations. People are keen to bottle the Older Adult experience i.e. excellent care, which was also noted (and tweeted) by Aidan Fowler, formerly our Acting Medical Director and now Public Health Wales Director for NHS Quality Improvement and Patient Safety (@aidenfowler1000). Matt recognised that our staff are kind, welcoming, and consider the little things as well as the big things and thanked everyone for their hard work.
What Makes your Heart Sing Following this, Dr Natasha Lord, Clinical Psychologist, led the second presentation what makes your heart sing? An idea developed by Carmine Gallo, author of Talk like Ted; the 9 public speaking secrets of the world s top minds. He found successful, inspirational leaders such as Steve Jobs (CEO of Apple Inc) when asked about what made the job enjoyable for him, did not talk about the facts or what the phone was like, but about realising art and technology together. The aim of this question is to recognise those moments, not grounded in data, but where you feel that you had made a difference, where you feel connected to your job, where you have that tingle moment. Presenters were invited to share their stories and then each group shared theirs, firstly at their tables, and then to the larger audience. Staff were invited to write their stories down on paper. Some of the stories are given below (they are direct quotes from the members of staff). It was felt that this set the mood of the day and staff were inspired by the stories that they heard. Having a special bond with a lady with difficulties. Saying goodnight and see you in the morning. She replied saying I won t be here in the morning and said thank you. She passed away in the night. Team work means something special to me after losing my dear husband. My work colleagues covered for me when I broke down in a cupboard and were intuitive to my needs. I feel I could not have survived this loss without my colleague friends and manager Lady getting better, states that she does not want to leave as she is enjoying her time here. Tells me: it took four people to get me in here, and it s going to take four people to get me out When things feel so terribly empty and sad. But they leave with a future ahead of them and they are able to make plans A husband and wife both with dementia in a care home, they didn t know where they were, but would recognise each other. Putting on music and them remembering An anxious lady called out help me, help me, I went and sat with her and we spoke about her life and her interests and she enjoyed dancing. I asked her what her favourite song was and said I will be right back. I got the CD player and put on My Way, and we danced. Her smile brightened up the room and made me very proud A patient was crying and kicking his wardrobe. I went down the corridor and asked what was wrong. He had expressive dysphasia and put his arms out but could not express his issue. So I walked slowly towards him, touched his back and he smiled at me. I slowly moved closer and gave a hug and he cried with a smile on his face and soon calmed down. I felt proud.
Where are we now? Simon Kerslake, Acting Matron Lead Nurse followed on from Matt Stringer s opener to provide more in-depth information on our CQC rating (http://www. cqc.org.uk/provider/r1a) and what themes had come from the friends and family test (http:///ourservices/patient-experience/ friends-and-family-test/). Again it highlighted the compassion of our staff, their ability to go the extra mile, and the recognition of the little things that can make a difference in someone s experience. Staff were invited to share positive comments and feedback that they have received from staff and carers. Everyone is so kind and caring here. It is like a hotel, I don t want to leave Patient Thank you for listening and just being there Patient You ve all done an excellent job looking after my husband Carer Thank you for looking after my mum. We will never forget you and this lovely ward Carer Thank you for giving me my life back, I never thought I would feel well again Patient Staff also highlight the number of gifts that they had received, including money to develop a sensory area for people with dementia, a free standing hair dryer, a TV and numerous chocolates and cards.
AIMS Accreditation Tony Braker, AIMS and Safewards Lead gave a presentation on the Accreditation of Inpatient Mental Health Services (AIMS) by the College Centre for Quality Improvement (CCQI) AIMS is a standards based accreditation programme designed to improve the quality of care in inpatient mental health wards and AIMS- OP is specifically designed for inpatient wards that care for Older People. Accreditation assures staff, service users and carers, commissioners and regulators of the quality of the service being provided. Specific standards are provided for Older Adult Wards and can be downloaded from their website. (http:// www.rcpsych.ac.uk/quality/ qualityandaccreditation/ psychiatricwards/aims.aspx). Work has been undertaken to look at our areas of strength and identify potential gaps. Staff were all given a set of standards and were invited to provide feedback on their experience to date and any changes that they would like to make. Areas of work were shared, for example: 1. Admission and discharge pathways and care planning 2. Operational policy 3. Patient and Carer Information 4. Training Specific attention was given to the up-skilling of staff in both therapeutic training and holistic interventions. Staff were invited to request training that they felt would benefit the service and were made aware of the therapeutic training plan. Knowledge and Understanding Framework ( KUF for people with personality difficulties), Brief Solution Focussed Therapy (BSFT), Making Every Contact Count (MECC) and Newcastle Model (for understanding behaviours which challenge) will be delivered to all staff across the service. Recognition was also given to the internal training already provided and how this will continue to increase the psychological mindedness of the ward and providing a further range of targeted interventions. Staff reported that they felt included in the process and consideration was given to ensure on-going opportunities to input into the work, for example, Management supervision and the Innovation and Quality Meeting. Safe wards Safewards is an evidence based approach, which has ten modules designed to create a safe, therapeutic environment, where patients feel contained and reduces potential for conflict and distress (http://www. safewards.net/). Clare McFayden, Occupational Therapist and Safewards Lead for New Haven gave an overview of the modules already completed and some of the work undertaken, for example; Clear and Mutual Expectations, and Calm Down Methods. Staff were invited to nominate Talk Down Champions. Talk Down Champions are recognised for their abilities to understand a person s distress and be able to provide support to the rest of the staff team in their interactions. Jackie Adams, Health Care Support Worker and Paul Stokes, Assistant Clinical Practitioner were two members of staff who were nominated. Calm down boxes for staff were presented on the day, and were a big hit. Many of the staff ripped into the chocolate and popped the bubble wrap. Calm down boxes are available for both patients and staff on the wards.
Bibliotherapy Recognition was given to an innovative idea from a member of staff, which had received excellent feedback from patients about how useful and meaningful they had found it in their recovery. Bibliotherapy is an evidence based approach which uses words or art as a way of being able to identity with other s expressed emotions, thoughts or imagery. Bibliotherapy is the therapeutic use of reading to help mental or psychological disorders (Oxford Dictionary 2015) and is recommended for a number of difficulties, for example, generalised anxiety, common mental health disorders and depression. Sally Watkins, Ward Manager for New Haven Functional spoke of how her idea had grown and become a reality and how this had been achieved. The group is currently being written up for the British Journal of Occupational Therapy. Staff were invited to consider any idea that they may have and share it with the management team. This will be an on-going initiative, with staff to consider new ideas at the bi-monthly Innovation and Quality Meeting. Collaborative Care planning Tracy White, Ward Manager New Haven Dementia gave an overview of how we were moving towards collaborative care planning. This initiative bring together the wealth of experience and skill across the multi-disciplinary team, including ensuring our patients and carers are given opportunities to feed into their plans and builds on best practice. Staff were invited to think about how they could make this better and suggestions were captured; 1. Only writing care plans which are relevant for the person. Consider the needs of the person and what the risks may be 2. Share with family and at the MDT review 3. Highlight the importance of care planning for prevention 4. Family involvement to be recorded more easily 5. Develop a care plan index and reference to the notes 6. Patient information board, making sure that the careplan and the patient information board are linked 7. Meaningful daily note observations Delayed Discharges Research Dr Lathika Weerasena, Consultant Psychiatrist fed back on a piece of research undertaken within the trust exploring our admissions and discharges to New Haven Ward for people with dementia in its first year of opening. The study evidenced that a number of admissions occurred out of hours and on a Friday and a Sunday. It also identified a number of admissions occur for people with dementia due to behaviours which challenge. 45% were emergency admissions. The research highlighted that currently we do not evidence inclusion of the care coordinator and the recognition of the importance of this role in supporting discharge from the ward. The study proposed questions which may help to shape some of our processes and support for carehomes, for example, do we need to think about early recognition of difficulties to prevent admission to hospital. Please see Dr Weeresena, Consultant Psychiatrist if you would like further information on this project.
Care notes Implementation Dawn Pattison, Operational / Clinical Project Manager gave an overview of the implementation of Carenotes. Worcestershire Health and Care Trust is moving towards a paperless system and Dawn explained the process of how this would happen and what services needed to implement in order to support this process, for example, identifying Super-users who will support others in moving towards an electronic system. In short Carenotes will support the drive to maintain or improve: 1. Quality - Patients will only have to tell their story once as we ll be able to share information across professional disciplines and teams, resulting in a better overall experience for those accessing our services. 2. Safety - A single electronic patient record which can be accessed by other teams and professionals will ensure staff have up to date information, which can also be shared with staff from partner agencies 3. Efficiency - Consolidating numerous systems into one will support the organisation s drive to work SMARTER to increase efficiency (HACW intranet, 2015) Patient Experience Questionnaire Patient experience can only be improved by analysing and understanding patient satisfaction with their own experience (Darzi, 2008. High Quality Care for All). Recognition is now given that in order to provide high quality care and ensure safety and effectiveness, trusts must actively seek out opinion and a person s experience of their care and treatment as well as complaints and operational data. The data must be used at all levels of the organisation to ensure staff are aware of the impact that their attitudes, behaviours and poor communication has on patients and their families (NHS Outcomes Framework, 2012; CQC 2013; Francis Report, 2013). In April 2013, it was made mandatory for all NHS trusts to offer the friends and family test. However it is recognised that this provides minimal feedback to services and trusts are recommended to undertake more robust evaluations. Bharath Sarangapani, Acting Ward Manager gave an overview of the Patient Experience Schedule which will be implemented in October. The Patient Experience Schedule covers Admission and Discharge, Involvement with staff, Involvement in care, treatment and support, safety and suitability of the ward, environment, and sharing views, complaints and compliments. The questionnaire was devised using national standards in collaboration with Experts by Experience. The questionnaire will run for 6 months and a summary report will be provided, with recommendations for service improvement. All recommendations will be reviewed and implemented via the Leadership team. Please see Dr Natasha Lord, Clinical Psychologist or Bharath Sarangapani for more information.
If you were a Matron Lead Nurse for a day, what changes would you make to the ward? Finally staff were invited to think about changes or ideas that they would like to implement if they were matron lead nurse for the day. Dr Natasha Lord, Clinical Psychologist told that there was no remit, and to allow any idea which they thought would make a difference. Below are a list of the ideas presented. A number of ideas came up over several days and these have been combined, for example, providing a cinema experience. The ideas have been put into themes for ease, these include: Social activities, physical changes to the environment, activities, staffing, therapeutic involvement, pets/animals, food and the Welcome pack. Ward staff will be allocated an idea to take forward. This will be an on-going project and reviewed with the Innovation and Quality Meeting, and the Inpatient Leadership meeting. Theme Social activities Physical changes to the environment Staffing Pets/ Animals Activity Food Idea Theatre production, Tea dance, Cinema nights, Food tasting from around the country, Cruise themes events from around the world, Dementia adventures, Minibus for days out - days out include: swimming, lunch, coffee, countryside centre, Theme days such as V day and everyone wear costumes, Day trips, Dancing, Takeaway nights, Bingo (with proper prizes), Singer, Regular special events, Picnic in the grounds, Music played on the ward Night staff wear pyjamas, Quieter alarms at night, Soft closing doors, Sensory room - soft furnishing and light boxes, Soft room, Jacuzzi, Male and female lounges, Proper board for visiting times and displaying of information, Food court, eat central type involvement, Soft flooring, Memory lane Dementia Village, Double beds, Sauna, whirlpool, hot-tub, More homely environment such as pictures, throws, soft furnishings, Air conditioning throughout Ward social worker, More staff so there are no bank or agency staff where possible. Dedicated bank and agency staff for when they are needed, 1:1 staffing to patients Animals living on the ward, Animals living on the allotment, Rabbits / Chickens /Fish, Pond with fish / Aquarium /Aviary, Visit a zoo, Ward cat and dog Beautician and hairdresser, Gym Cooked breakfast on the weekend,?whether patients have a cooking group on the weekend, BBQ, More than one ice cream scoop, Different flavours of ice-cream Therapeutic involvement Training for staff, Increased number of therapies available, Music therapy, Drama therapy, Holistic therapies, Sports such as tennis and football, Complimentary therapies, Aromatherapy, More organised wellbeing clinic, Ward leads to liaise regularly, Petty cash for patients to promote independence and recovery, Photography group Welcome Pack Map of the ward
Feedback Staff reported that they had an uplifting, enjoyable and informative day. A consultant psychiatrist reported that he had never seen so much energy at an end of the day and the number of ideas generated. Recognition was given about celebrating all staff skills, experiences and ideas, and how these can be cultivated to provide a centre of excellence. Actions Since the Away days, work has continued to be undertaken based on what has been suggested. The matron for the day themes have been collated and staff are considering the ideas and planning how these can be taken forward. Work continues on Safewards and AIMS project. New Haven will be peer reviewed on the 14th October 2015 and Athelon Peer Review is 27th October 2015 for AIMS accreditation. The Project group continues to gain pace, with the production of the ward videos (patient and carer information), new documentation and the implementation of new initiatives such as the Carer Link. Recognition of the needs of carers has led the Service to sign up to John s Campaign. John s campaign is promoting the needs and importance of carers in providing quality care for people with dementia when they are admitted to hospital. As a service, we recognised that this need was also the same for our people with functional mental health needs and that they need access to the same level of resources and be able to see their relative as often as they need to. Subsequently we now offer specific carer leaflets, dedicated carer resources, a carer forum and regularly request feedback to ensure the best quality service (http://www. johnscampaign.org.uk/). Dementia Words Matter has also been agreed and signed up to by the Older Adult Mental Health Inpatient Service, as we recognise the importance of the language that we use and the impact that this can have on a person s sense of identity, self worth and esteem. Posters and recognition of these have been put up on the ward (http://www. dementiaaction.org.uk/dementiawords). Newsletters are regularly sent out highlighting work undertaken and informing staff of new initiatives. Please ask any member of the staff listed below if you would like any more information: Tony Braker, AIMS and Safewards Lead Simon Kerslake, Acting Matron Lead Nurse Tracy White, Ward Manager New Haven Dementia Sally Watkins, Ward Manager New Haven Functional Bharath Sarangapani, Acting Ward Manager Athelon Clare McFayden, Occupational Therapist Dr Lathika Weerasena, Consultant Psychiatrist Dr Natasha Lord, Clinical Psychologist