VOLUME 1, ISSUE 4 DECEMBER 2017 QI Network Newsletter Mental Health, Psychology services and CAMHS National Clinical Director of Healthcare Quality & Looking to publish Strategy REH visit (Jason Leitch) your QI work? On the 12 th October 2017 I my part – it was arrived at the Royal Edin- the systematic burgh Hospital and met a nature of the Scottish Quality & Safety approach to Fellow who I thought was change. The ap- going to show me an excel- plication of qual- lent quality improvement Anyone can access BMJ Qual- ity improvement ity by using the details below: project. methods at scale is, of course, a In order to gain access to BMJ What I actually experi- series of micro Quality, please go to http:// enced was a hospital-wide, system projects quality.bmj.com/ systematic approach to which succeed redeemcodeuser and select the improving processes and best when they are linked to shine a light on the pro- 'Redeem access code' button. outcomes for patients, to a common purpose, a gress that’s being made. families and carers using capacity and capability 2. Focus on the service Please follow the instructions quality improvement meth- plan and people who genu- user. My experience of and when prompted, enter ac- ods across the hospital. inely care about making it mental health quality im- cess code: 7236075160 better for patients and provement is that it is bet- I met multi-disciplinary families. Geeky maybe, but ter at involvement and en- teams who had co-designed very apparent at the Royal gagement of patients and quality improvement pro- Edinburgh. families than other sectors. Inside this issue: It is unusual to find pa- In my final meeting tients on improvement Promoting cycling 2 of the day, a trainee teams in acute care set- and walking in psy- oral surgeon on his tings. This is not unusual in chiatry rehabilitation mental health rota- mental health. My experi- tion described a new ence suggests that service Sharing improvement 2 initiative linking all user involvement leads to ideas across teams in of my worlds: quality better choice of outcomes CAMHS improvement for oral and accelerated improve- hygiene in mental ment. Pass plans in Adult 3 health inpatients. He 3. Keep the faith. The lit- Acute Mental Health jects based on priorities was a lovely guy, he’d just erature calls this advice across a broad range of started the project and in a REH Clinical Change 3 “relentless focus”. Im- mental and physical health few months he was plainly provement is not only hard, Forum challenges. For example, I going to make a real differ- it also takes longer than Use of metformin for 4 didn’t expect to meet an ence to patients’ oral you first imagine. It re- antipsychotic-induced Occupational Therapist health. quires stickability, courage leading an improvement weight gain and determination. project which included When I was kindly asked Physical health moni- 4 innovative health interven- for my advice after my The systematic approach to toring of patients tak- tions such as bike mainte- visit, my contribution is change that I witnessed at ing clozapine nance, cycling around the simplistic and three-fold: The Royal Edinburgh is an Royal Edinburgh grounds, 1. Celebrate success. It example to others on this Psychodermatology 5 a weekly walking group seemed to me as is often journey, and I have already with a café stop – all to the case, the teams and shared my experiences improve rehabilitation for leaders hadn’t fully appre- from this visit to encourage psychiatric patients. ciated what they were and illustrate what it is achieving. Systematic im- possible to achieve. Thank The most impressive thing provement is hard and of- you to everyone who made about my visit was in fact ten you need external eyes my day possible. quite a geeky reflection on Promoting cycling and walking in psychiatric Want to know more? rehabilitation (Laura Dickson) WE Occupational Therapists have an important role to play in health pro- ARE motion within both rehabilitation and acute wards, and are well placed to influence how people’s choices and routines can directly impact their ON physical and mental health (College of Occupational Therapists, 2006). THE The benefits of regular low-impact exercise like walking and cycling WEB! are well documented, such as reducing the risks of coronary heart dis- ease, stroke, cancer, obesity and Type 2 diabetes, as well as promoting mental wellbeing (NICE, 2012; Scottish Government, 2016). Lothian Quality, Better Health, Better Care, Better Through partnership working with third-sector organisations including Value, is the website dedicated to quality improvement and it Scottish Association for Mental Health (SAMH) and My Adventure, is now up and running and can Occupational Therapists at the Royal Edinburgh Hospital have be found at created various health promotion groups on Myreside ward, https://qilothian.scot.nhs.uk which include a walking group and cycling group. There has been a demonstrated need and interest in cycling on the rehab wards for some time and this was brought together in a group format, giving patients the opportunity to learn skills around fixing bikes, practice safe cycling within the grounds and ex- plore community resources. Building on the success of the walking group and interest from patients who used to cycle, or had expressed an interest in cycling, QI Training the idea came about to rescue some abandoned bikes around the Royal Edinburgh site, and do them up with some assistance. This If you are interested in train- ing with QI Academy, please was facilitated by the support of Myreside nursing colleagues and contact your local QI Lead: help from cycling organisations My Adventure and Sustrans. The group aimed to cover both basic bicycle maintenance skills, • Jane Cheeseman • and guided 1-1 cycle rides around the hospital grounds, and then Belinda Hacking local cycle paths in a group once riders had demonstrated they • Patricia Graham could ride safely. The creation of the walking and cycling groups • Cathy Richards have led to increased patient participation in exercise and time spent outdoors, and reinforced the benefits of active travel to ex- plore the local community. A further goal was to encourage individuals to set healthier goals that they can take forward with them on their move from hospital to the community setting. Sharing Improvement Ideas across teams in CAMHS Twelve months ago the national Mental Health Access Support Team ran a work- shop for CAMHS team to support the service using the model for improvement to improve the clinical pathways for Autism Spectrum Disorder (ASD). On Novem- ber 14 th 2017 the teams gathered to share ideas for improvement that had been tested over the past year and welcomed the ADHD teams who had also been using the model for improvement CAMHS. Nine teams presented data from the assess- ment and post –diagnostic pathways for ASD and ADHD. Presentations were delivered by teams who were at various stages with their QI journeys. One popular change idea had been tested by 4 teams of using of an allo- cated assessment information gathering meeting. Teams typically suggested that this meeting required specific paperwork to be completed and an allocated timeslot. Other common change ideas included letters to parents summarising the assessment pathway and storing resources electronically on shared drives for easy access. The teams who were towards the end of their tests of change illustrated positive improvements to timeliness and consistency. For example the North Edinburgh ASD reported a gradual reduction in wait times for ADOS assessments despite a huge increase in demand, while West Lothian found that parental attendance to the large ( 35+ families) post-diagnosis parents groups was equivalent to attendance at the small (~9 families ). Suggesting that working with the larger group may be of benefit in terms of service efficiency and improved access for parents. At the end staff shared that they felt empowered by using the model for improvement their QI projects. Comments also included that staff were glad to be able to measure the impact their changes had on referrals and waiting times without the requirement of large datasets. Most of the staff who presented projects had also attended a QI coaching sessions earlier in the year. The impact of the coaching was assessed; following the coaching staff reported having a better understanding of QI and increase confidence about their projects. CAMHS are very grateful to the QI Academy and the MHAIST team for support, coaching and training. 2 QI NETWORK NEWSLETTER Pass plans in Adult Acute Mental Health (Eileen Clark) As part of my role as Quality Improve- and looked at the compliance rates of been achieved by providing the wards ment Nurse for Adult Mental Health specific areas within the pass plan. with regular feedback in regards to their (AMH) services I was asked to look These were the details which would be progress and providing them with evi- the pass plans with the acute mental most important should someone go miss- dence of their progress to display in the health wards. Pass plans are used to plan and prescribe a patient’s time off the ward and should be agreed with the patient and the multi- disciplinary team. All inpatients should have a clear plan in the front of their notes. This infor- mation should also match ex- actly to the information written on the Patient Status at a Glance (PSAG) board in the ward duty rooms. The aim and purpose of carrying out this piece of work was: ► To ensure that all pass plans were ing from hospital or fail to return from a clinical areas.