Using coaching to Improve care for vulnerable older patients

1. Using coaching to Improve care for vulnerable older patients Clare Abley Nurse Consultant Vulnerable Older Adults The Newcastle upon Tyne Hospitals NHS Foundation Trust

2. Background • New to Directorate of Medicine • Way to engage with Sisters – gain their commitment • Improving care for vulnerable older patients – key part of nurse consultant role • Way of informing staff about my priorities • Reinforce importance of providing high standard of care for vulnerable older patients – especially on medical wards (as opposed to OPM) • Complaints – anecdotally – increasing numbers concerning care for older frail patients – complaint numbers for Q1 2011/12 (see next slide)

4. 14 key areas In relation to your ward, for each of the elements of clinical practice listed in the table below, please rate on a scale of 1-10 how good or bad practice is at the current time, where 1 = very poor and 10 = excellent. Your responses will form the basis of discussions at our initial meeting. • Current rating (1-10) • What rating do you want to achieve in 6 months time? (1-10) • In 12 months time? (1-10)

5. Treating patients, relatives and carers with dignity, respect and compassion Communicating effectively with patients, relatives and carers   Assessing and managing patients’ nutritional needs (food and fluids) Assessing falls risk and preventing falls   Successful transfer of patients back to the community   Assessing and managing patients’ elimination needs (bladder and bowels)   Meeting the needs of patients with cognitive impairment e.g. dementia   Identifying, assessing, treating and managing patients with delirium (acute confusion)  Assessing and managing pain  Meeting patients’ hygiene needs (including oral hygiene)  Preventing pressure ulcers and assessing and managing wounds  End of life care  Safeguarding vulnerable adults (identifying when to make an alert, participating in safeguarding meetings etc)  Learning from complaints and incidents  Other:

6. Some principles of coaching • About individual people • Need to know the person • Mutually respectful and adult centred • Based on rapport • Putting aside own needs • Individual maintains responsibility for own goals • About improving performance • Goal orientated – personal, team or corporate • Providing feedback, motivation, questioning • A process not an event • Building relationships and skills takes time • Involves a wide range of skills, attributes and opportunities • Opportunity to learn with the coach , not from the coach

7. Coaching model: GROW (Whitmore – Coaching for Performance) • Goals – what do you want to achieve? • SMART • Is it positive, desirable, challenging and attainable? • Reality / current situation • Ask clarifying questions: what action have you taken so far, what worked, hindered you? What factors have been important in past successes? Who else is affected? • Options • Draw out as many ideas as possible: what other options do you have? What else could you do? If time and resources were not an issue, what would you do? If you were the boss what would you do? • What will you do? – Check for clarity, confidence and commitment? • What is the first step? What are you actually going to do? • What obstacles might you meet on the way? How will you overcome them? • What support do you need and who from?

10. Examples of actions • Consider implementing a system nurse buddies / critical friends to improve dignity • Workshops on dealing with and learning from complaints for Sisters and ‘other staff’ • Establish a ward training programme • Improve nurses’ verbal and non verbal communication skills when dealing with relatives (use of Simulation Centre) • Select and introduce a delirium screening tool • Reintroduce Lockwood oral assessment tool • Introduce a pain assessment tool (liaise with other sisters and palliative care) • Buy a camera to photograph wounds (share with another ward) • Improve completion of discharge checklist • Junior and senior sister to attend Level 2 Safeguarding Adults Training Day • Improve speed of referrals to stroke rehab – raise issue – discuss and agree action at MDT Stroke meeting • Use a root cause analysis to raise issue of patients being transferred with pressure ulcers and staff not being informed • Instigate a checklist to complete for verbal handovers • Develop a system for gaining patient feedback in the Day Hospital

11. Any questions?