Communication at Transitions

11.15 - 11.20 Introduction – Samantha McEwan 11.20 - 11.35 The social context of discharge – Ruth Kelly 11.35 - 11.50 The benefit of using Safety Briefings – Michelle Skachill and Alistair Carlyle 11.50 - 12.00 Questions and Answers – All presenters 12.00 - 12.15 Workstream essentials 12.15 - 12.30 Whole group discussion

#spspmh5

RUTH KELLY

#spspmh5 TODAY LAMH BACKGROUND • History • Services NORTH LANARKSHIRE SERVICE MODEL • Development and Implementation • Outcomes • Statistics • Process and Practice WHAT WORKS • Christine's story

BACKGROUND INFO

 1983: Association formed  1983-1989: Supported accommodation and Day Care services in Hamilton/ Blantyre.  1990- present: Individual Support services developed in Lanarkshire and more recently West Lothian  Employment services Workshop/New Futures/Job Brokerage/IPS  Social Enterprise development: LAMH Recycle  Grant funded work e.g. Lottery/TSB/Robertson Trust/Scottish Enterprise/ UK Steel enterprise fund

PRESENT: OUR SERVICES South Lanarkshire  Source Home Support Day Care and Crisis service  World of Work  Hamilton Supported Living Services North Lanarkshire  Individual Support service West Lothian  Housing Support Mental Health/Substance Abuse service Other Business Initiatives  Hamilton Charity/Information shop  Mental Heath First aid training  Scottish Mental Health Cooperative  Fundraising  Ingeus Work Programme provision NORTH LANARKSHIRE SERVICES

CHANGES AHEAD!

May 2011: Steering group established to focus on what would better services look like?  Shifting the balance of care  Review the use of commissioned mental health services in NL  Look at changes in Community Mental Health teams  Recommendations were made to Mental Health Partnership Board for SAMH (Clubnet) and LAMH services to be redefined  Partnership Working agreement developed to provide an integrated short term support service

Key service changes

SERVICE REDESIGN JANUARY 2013  To provide short term individual support to people who have experienced a significant deterioration in their mental health which would otherwise precipitate their admission to hospital  Support to people who are in hospital to aid transition  7 day service including access to senior duty worker 8.30am-8pm  LAMH staff to be based in CMHT in 6 localities of North Lanarkshire

WHAT ARE THE POSITIVE OUTCOMES FOR PEOPLE?  People will have improved mental health  People will have received timeous support to overcome immediate crisis and have been helped to develop effective coping mechanisms  People will have improved quality of life, confidence and self esteem and an increased sense of control over their wellbeing  People will have their views sought and heard regarding their personal outcomes and how they will be met HOSPITAL DISCHARGE

STATS: • 52 people over 2 years • 18% of our total referrals • The majority had been in hospital for 6 weeks minimum. • 10 people went on to receive SDS • On average people received support for 8-12 weeks PROCESS AND PRACTICE

REFERRAL  Lead professional/Care Manager  Identified outcomes  Levels of support required  Care team access SUPPORT PLANNING /INTERVENTIONS  Iroc  Aspirations planner  Recovery REVIEW  Within 1 week of discharge  2 weekly thereafter

WHAT WORKS  Getting to know the person on the ward prior to discharge  Support on passes  CMHT allocation meetings  Attending MDT reviews on ward  Consultant support  Liaising with family members  Care package that met needs  Flexible support times that worked around home care/family etc  Shared information/risk assessments

Christines Story Safety Briefs – NHS Dumfries & Galloway Experience

Does anyone I wasn't told Are we know if...? about that expecting an Has admission? anyone ordered ...? Has anyone contacted... Has that about..? been reported? The overall aim is: • To create a culture of safety through improved communication which enhances patient safety, raises awareness, reduces risk and improves overall quality of patient centred care So what did we do? • Developed a PDSA!!!!

This is included: • Communication with staff to explain rationale • Displayed flipchart to gather ideas from all staff • Networked with other areas to see what had already been done – Stratheden • Developed a draft template to test out

Then what did we do? • Tested it out • Tweaked the template • Gathered feedback from staff through use of short questionnaire and team discussion • Eventually, came to agreement on format and template

Content of safety brief • Patient info • Medication • Physical issues • Safety notices • Environmental • Staffing

Early shift Late Shift Night Shift Donna Sharon Haley

Thursday 26th 2015, Date to be changed by early shift. Ensure allocated staff name is added above on each shift.

AW returned to Ettrick via police .prn utilised appears settled on update. Patient Info CR admitted to Ettrick. Previous high risk for A&V. May require joint assessment

If staff available offer support to Nithsdale AM and Cree PM for a1-2hrs to help with personal care. Medication Pods – weekly checks done February. (Errors, Kardex issues, Please ensure that all PODs are checked when completing weekly order. Out of stock) Physical issues CH needs Clozapine bloods done 11am (Falls, bloods, all other physical matters) Safety Notices (Drug alerts, Health Please return patient’s toiletry items to Sluice Room after use and mark as and Safety, Infection returned. Control. Environmental Please remember to double lock the Clinic door. Issues Cortex has not been saving notes. IT has been informed and they are dealing (Maintenance issues, with this. equipment etc) Kettle in use at present. Boiler out of order . Staffing Floor Nurse: A.M: Donna P.M: Sharon N/D: Haley (New staff, Bank, Medication: A.M: janine P.M: Chris N/D: Elmarie Induction etc) Nurse in Charge: A.M: Chris P.M: Wendy N/D: John

Bank shifts -: Outside office hours or the weekend check the “folder of availability” contact those individuals first then others as we did previously. During office hours texts to available bank staff sent from Reception. Other If “out of hours” we are asked to respond to attacks in other wards and can’t due to our own clinical activity, ensure we contact the SCN/CN on call to let them know rather than contacting wards.

Challenges • Consistent information/quality of completion • Keeping it live • Deciding what’s relevant • Who’s responsibility? • Getting everyone to contribute • Electronic version? • Keeping it brief! Where are we now? • Embedded into practice – Balcary and Dalveen • Routine part of handover – could be several times a day • Happy with core template – customising to individual areas • Continuing gathering ongoing feedback from staff • Creating new ideas

Next steps • Review the quality of information • Keeping it slick and effective • Keep refining and standardise • Spread to other wards ( incl. older adults) • Integrate into “huddles”

Questions and Answers

Samantha McEwan Ruth Kelly Michelle Skachill Alistair Carlyle

#spspmh5 Communication at Transitions Essentials

• Admission/Discharge – including discharge pause 24 hours in advance of discharge • Daily goal setting/What matters to you – developed in Person Centred • Safety briefings and huddles • Early warning systems – deteriorating patients (physical and mental health) • Absconding/ missing persons/ pass plan for LOA

#spspmh5 Workstream essentials – questions/issues

• Are they correct? • If not, what should they be? • What are we already doing? • What change packages, bundles, interventions should be developed and tested to deliver them? Lunch – available outside Strathallan Foyer and opposite Stuart Lounge Storyboard viewing – Strathallan Drop in data surgery - Glenallan