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Welcome all!

Welcome all!. Maz Marsham Lead Nurse Bromley CLDT, Oxleas NHS Foundation Trust Claire O’Brien Associate Director of Nursing, South London Healthcare NHS Trust. What we did Oct 2010 - Feb 2010 (‘baseline’). Did what we had always done! Made a plan….. ……changed the plan. What we did.

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Welcome all!

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  1. Welcome all! Maz Marsham Lead Nurse Bromley CLDT, Oxleas NHS Foundation Trust Claire O’Brien Associate Director of Nursing, South London Healthcare NHS Trust
  2. What we did Oct 2010 - Feb 2010 (‘baseline’) Did what we had always done! Made a plan….. ……changed the plan
  3. What we did Lucy, David, Keith. What if a big problem with discharge planning was that we never knew they were in hospital in the first place? What if the most important things we needed to change happened before the person was ready for discharge ? What help did people really need, and when? How would it get started?
  4. What we did Lucy, David and Keith taught us: Work together even if things have not gone well Use the medical notes Tackle internal communication and role issues Don’t delay in letting us know about admission because you aren’t sure if we can help or not Urgent admission is a big health deal : we need to make contact and share information, flag it with clinical leaders, do proactive liaison work. Once is not enough! You may be saying it for 10th time, to 10 people who are hearing it for first time Start from scratch if you have to - patients get moved between wards, so start up interventions may be needed even if admission is lengthy What do we do when we get there? Everyone needs to provide the right intervention in right way at right time
  5. What we did Aims: LD urgent admission has standardised intervention from CLDN in timely fashion according to a joint working protocol Communication pathways between ward and CLDT established within 2 days of admission/alert Practice improvements must be sustainable
  6. What we did (March 2011-Oct 2011 - ‘Mid’) Case finding Retrospective and current data collection Telling people about the project, (and getting them to help us!) Focus groups held National Conference Draft CLDN procedure with 2day target
  7. What we did SLHT recognised excellent practice by Jean Diamond, who won the Patient Experience SLHT Staff recognition award.
  8. What we did - LD Awareness week June 2011 (mid) With permission, opportunistically swept 19 wards, 1 (genuinely) too busy to engage - 3 return visits. No patient with LD in PRUH who we didn’t already know about 4 wards had the poster on display, posters provided to those who didn’t. 3 had ward pack (update in production, electronic version?) 3 staff familiar with traffic light form, copies supplied to others Most staff unaware of CLDT support, but keen to hear about it, team leaflets supplied. 7 wards requested follow up visit or more training Stand in canteen entrance lunchtime: approx 100 people stopped, wide range of disciplines, patients, public MCA competition - who is the decision maker ? - 16/48 correct entries
  9. What we did LD awareness week 2011, 2012 Acute care is not by appointment - just turning up is good Training needs to be on site, quick but effective and flexible. Interest is greatest when patient with LD is on ward - timing crucial Potential champs out there, but might not be obvious…
  10. What we did
  11. What we did (Nov 2011 - Apr 2012 (‘post’) Initiated the CLDN Standard Operating Procedure proper Trialed the Proforma tool kit Drafted joint working protocol Analysed focus group transcripts Crunched numbers Maz on secondment
  12. What happened - scene setting 28 people had 54 urgent admissions 10 people died in hospital or shortly after discharge 677 bed days, (£135, 400) Approx 2 admissions per person Average length of stay 12.5 days (£2,500) (national average 5.5 days, £1,100) LoS range 1-96 days 32 % of admissions lasted >14 days, accounting for 74% of total bed days.
  13. What happened - scene setting 60% of admissions failed to reach the <30 day readmission target (financial penalty) 32% of cohort experienced readmission, 68% had single admission. Readmission days ranged from 1-150 days N of readmissions per person ranged 1-7 1 person had admissions in each data collection period, 4 people had admissions across 2 periods.
  14. What happened - scene setting 1 person required IMCA services by virtue of Safeguarding Adult status 2 people IMCA information was unavailable The majority of people had relatives involved in their care
  15. What happened - trends
  16. What happened - trends
  17. What happened - trends
  18. What happened - trends
  19. What happened - trends
  20. What happened - trends
  21. What happened - trends
  22. What happened - trends
  23. In summary………. LoS had got shorter Fewer people had readmission Fewer complaints were made CLDT response times got faster 2 day response target is possible ‘Never alerted’ admissions stopped Direct referrals from wards occurred The fewer people who did have readmissions returned more quickly The number of referrals taking more than 2 days to reach us increased
  24. What happened - perspectives Transition to adult services Not being listened to Feeling they could not leave their child because they would not receive personal care in their absence
  25. What happened - perspectives Confusion about their role on ward Complexities and tension in the working relationship with ward staff Conflict of interest between providing support on the ward and maintaining service at home
  26. What happened - perspectives Want to use CLDT for training, knowledge and support and improve communication with them (Not everyone knows they exist!) Having support from a ‘familiar face’ on the ward is really valuable
  27. What happened - perspectives Need to have clear lines of communication with PRUH to ensure contact is made on admission and involvement is at earliest possible stage LD awareness week activities had been useful, increasing contact initiated by wards
  28. What happened - perspectives Feeling afraid and anxious but comfort and information not forthcoming, feeling too intimidated to ask for help Feeling bored with little meaningful activity Poor communication skills, not listening to carers who were trying to help
  29. What happened - tools revised
  30. What next ? Project and LD Equalities group aims converging 14 recommendations made (see Exec Summary) Sustainability/embedding practice, training, audit/monitoring, working with carers, transition planning, patient with LD feedback mechanisms, prevention of urgent (re)admissions through LTC management and improving discharge planning Further project work a possibility Always open to suggestion!
  31. Early Audit Results
  32. Early Audit Results
  33. So your next patient has Learning Disability.What are you going to do ?
  34. Have you admitted an adult with Learning Disability ? Are you caring for a patient who has a learning disability* ? If so, please let us know, as we may be able to help you to support your patient during their stay. You can call us on 01689 853388 Mon-Fri 9-5pm, Please ask for Mel Blair, Vee Nathan Stella Haddow - Mendes, Tony Hollands or Maz Marsham (* you may know this as ‘special needs’ ‘mental handicap’ )
  35. Elderly care characteristics Diagnosis in context of dementia, acute confusion, cognitive impairment difficult Effects of immobility on health Longer stays assoc with risk of acquired infections, depression, boredom, loss of social functioning Need for health and social care sectors to work together
  36. What matters to patients: Good information provision Having confidence in staff Awareness and understanding of specific health condition Right treatment from right staff at right time Continuity of care Being treated as a person Partnership with professionals
  37. What matters to patients Feeling informed and being given options Staff who listen and spend time with the patient Being treated as a person not a number Being involved and able to ask questions Value of support services Efficient processes
  38. SLHT patient experience priorities Patients rating of the food Experience of leaving hospital Making sure patients understand their medicines and side effects Organisation of out patient clinics Making sure staff support patients with any worries or fears they may have.
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