Health Promotion Service Physical Activity Pathway Ward Based Audit Dec 13 Jan 14 Lydia Jenner Orthopaedic FY1 RIE
Physical Activity Pathway Audit Primary question: Is the Physical Activity Pathway being used by Health Care Professionals on the wards? -Patients chosen at random on one of four orthopaedic wards -Asked patients whether they had been asked about their levels of Physical Activity before by a member of the healthcare team -If so; by whom? Had they found it a useful exercise? How long had the conversation lasted? And finally; had it made a difference?
Setting Audit carried out at the RIE Orthopaedic Wards (Trauma and Elective) Trauma wards (108 &109) each 36 beds Elective wards (208 & 209) 24 and 36 beds respectively, often also used for trauma patients Trauma wards typical patient load: older age adults; fragility fracture (hip) multiple co-morbidities; approximate ward stay 4 to 14days Elective wards typical patient: middle age adults; elective joint replacement (knee); some co-morbidities (arthritis; diabetes; COPD); approximate ward stay 3-4days Audit carried out over Christmas/New Year period less elective patients; staffing levels reduced; less continuity of care
Results so far 31 sets of patient data collected so far; only small sample size! Age range 29 87, Mean age: 61.03 Male : Female ratio 13:18 Percentage asked about Physical Activity levels: 9 patients (29%) 9 Patients 4 - GP 3 - Physiotherapist 1 Asthma Nurse (GP) 1 Pre-op assessment Therefore only 4 out of 31 patients asked about levels of PA during current inpatient stay.
Cont. Out of 9 patients asked about PA; 8 were interested to discuss PA and received brief advice/more thorough intervention Advice/interventions ranged in time duration from 2 mins to 15mins Out of those 8; 6 patients intended to follow some of the advice given to them to increase their levels of PA.
Feedback from Patients High level of interest from patients. Patients were happy to discuss Common patient perceived barriers to PA age, weight, co-morbidities (arthritis), un-aware of availability of local facilities Patient perceived barriers to Healthcare Professionals discussing PA time restraints, priorities.
Incidentally Physical Activity Pathway not openly displayed on any of the four wards Staff unaware of PA pathway & minimum levels of activity/week Impromptu poll of staff: 10 junior doctors 3 orthopaedic registrars 1 Medicine of Elderly registrar 1 MOE Nurse Practitioner 4 Orthopaedic Nurses 4 Physiotherapists 1 Pharmacist Not one member of staff asked has used the PA pathway Only one member of staff asked had heard of the PA pathway.
My Experience of using the PA Pathway -patients were generally interested and engaged in conversation easily -patients commonly stated co-morbidities as barrier to being more active but were able to do at least one form of exercise -simple tool to use; exit pathways useful for patients who are clearly disinterested.
Conclusion High level of patient interest Not being implemented on orthopaedic wards presently Low level of staff awareness
Suggestions Enrolling Junior Doctors Opportunities to promote PA pathway to junior doctors: -the Shadowing week lectures at the start of FY1; mandatory lectures for the new intake of junior doctors in July. -FY1/FY2 mandatory teaching held once a week at every hospital, include in the curriculum to promote to current Junior Doctors
Suggestions cont. - Potential to include a few questions about levels of PA in the Admission document
PLANNING AHP ROLL-OUT Chris Kelly Health Improvement Senior Kat Savage AHP EPR Project Lead
AHPs and Electronic Patient Records Why EPR? In line with NHS Scotland's ehealth Strategy, NHS Greater Glasgow and Clyde acute sector is moving to paperlite working Work to date: 600 WTE PT / OT Acute Staff 60,691 New Patients per Year Estimated 359,393 Sheets of Paper per Year 120 Versions of Documentation 8 electronic forms (eforms) shared documentation 23 word documents
AHPs and Physical Activity AHP Directors Pledge: We will work with a range of partners to increase the level of physical activity in Scotland CEL NHS staff routinely highlight the importance of physical activity for patients in hospitals as part of their rehabilitation and for prevention of future illness A Games Legacy for Scotland "We want to inspire the people of Scotland to be more active. To take part in physical activity and sport. To live longer, healthier lives."
What are we asking? Within the AHP Record of Care eform, the physical activity question is embedded. This eform will be used during every inpatient Physio and / or OT episode of care.
Training NHSGGC s 1 hour generic Raising the Issue Physical Activity topic bolt-on Health Scotland's Raising the Issue of Physical Activity e-module
Benefits All staff will be asking the same questions Shared documentation cuts down duplication Signposting information available to all online Plan to extract information to audit number of patients who were asked the question
Challenges Tackling knowledge and behaviour of staff Measuring impact Training staff ahead of roll out of electronic documentation.
Next Steps Train 600 wte Physio s/ot s Pilot template Create a data reporting mechanism to allow for audit
Thank you! Chris Kelly 0141 201 4956 Chris.kelly@ggc.scot.nhs.uk Kathryn Savage 0141 201 1525 Kathryn.Savage@ggc.scot.nhs.uk
Promoting Physical Activity in Palliative Care Mandy Trickett Macmillan Physiotherapist Macmillan Day Care Unit, Specialist Palliative Care Services, Dundee mandy.trickett@nhs.net
Background 2007 2010
Questions. Evidence? What was happening elsewhere? Scoped local exercise classes and other hospice exercise classes. E-networking UK and worldwide benchmarking What did the patients want? Would it benefit the organisation?
AHP Practice Development Apprenticeship Scheme (Sept 2012 2013) Aims : To support development of AHPs evidence based practice Improvement demonstration to develop AHP as leaders for practice development. Philosophy: Learn as you do through group based activities and practice based learning. Led by Dr Jacqui Morris, funded by CHPO (Jackie Lunday) Tayside Centre for Organisational Effectiveness MCN Lead for Nutrition supported by AHP directorate
Outcomes of interest Improve QOL Improve physical performance More patients seen in a group setting Patient centered approach Staff engagement in promoting physical activity
Methods Participants all patients who attended April Oct 2013 23 ½ hours video, focus group work All new patients screened using Scottish Physical Activity Pathway referred to physiotherapy or given information. Intervention 8 week circuit based exercise class - strengthening, cardiovascular, balance, flexibility exercises using evidenced based guidelines. pacing, planning, exercise diary, goal setting, relaxation, motivational interviewing Health Behavior Change. Outcomes -- Improvement tools used to develop and design the programme. Range of validated outcome measures used to assess change.
Literature review Improvement Tools Stakeholder communication Communication plan Project Definition statement Process Mapping patient pathway Driver diagram Project plan Informing, Engaging, Consultation Plan (IEC) 23 1/2 hours, gained patient feedback - focus groups, flip charts, information leaflets, emotional touchpoints, Data collection Staff engagement patient documentation
Results 18/89 patients took part in the exercise group. (cancer n=9, COPD n= 5, MND n=2, MS n=1, cardiac n=1) 50 % dropped out due to disease progression, 9 completed. 7/9 - increase in physical performance, Palliative Performance Scale and QOL. 2 /9 - decrease in physical performance, Palliative Performance Scale but QOL still increased. 3/10 - taking part in an exercise class was important to them. 7/10 - would prefer other types of activities such as walking, gardening or Chi Gung to help remain physically active. Patients who completed, reported their general physical activity levels had improved More patients were seen in a group setting Daycare staff became more pro-active in addressing patients activity levels.
Measureable outcomes - tested before and after the exercise class
Benefits of the project Patients Express their choices Demonstrated benefit Significantly more active afterwards Equal access Group exercise - evaluation Organisation Proof- evidence based, equally accessible and effective Person-centred approach Increased use of resources Staff Evidenced improvement and patient centred care Utilise time more effectively Have feedback on patient choices
What is the situation now? 1 100% of all Macmillan Day Care patients have their physical activity levels screened on admission and promoted in line with Scottish Physical Activity Questionnaire/Pathway 2 Group exercise (circuit class) is available for all patients based on need not diagnosis. 3 Patients are taught self-management skills such as pacing, planning and goal setting to continue to remain physically active and independent for as long as possible. 4 Next steps Walking programmes and Chi Gung (like Tai Chi) are now under development for those who do not wish to or are unable to take part in an exercise group but would like to undertake physical activity. New IEC plan.
You matter because you are you, and you matter until the last moment of your life. We will do all we can, not only to help you to die peacefully but also to live until you die. Dame Cicely Saunders (founder of the modern hospice institute)
Thank you.
Closing Remarks Be a champion and raise awareness with your colleagues Lead by example through your own practice and physical activity Use and promote the professional support tools available Link with your HPHS Lead, Physical Activity Lead and QI colleagues to collaborate on projects Make sure you work is recorded and recognised Share your practice with professional peers and through national groups
With many thanks to our collaborating national and local colleagues who have supported, contributed to and influenced the work to date. With particular thanks to: - Event Steering Group and planning team - All our presenters - All our facilitators - All delegates for their participation - All marketplace presenters - All those sharing work on our interactive wall Please share your learning and reflections from today with your colleagues, and signpost them to our resources.