Emotional Well Being on an Acute Stroke Unit Implementation of a Mood Screening Pathway

1. Emotional Well Being on an Acute Stroke UnitImplementation of a Mood Screening Pathway Walsall Healthcare NHS Trust Dr Amanda Campbell - Clinical Psychologist Sonia Jenkinson - Lead nurse

2. Acute Stroke Unit • 28 bedded combined acute & rehabilitation ward • 14.5 days average LOS – 45% discharged by day 7 • 420 stroke admissions per year • Integrated stroke service • Hyperacute, acute, ESD, rehabilitation, long term care • 1.00 WTE psychologist across whole pathway • Life time psychology service

3. Why is emotional wellbeing important • Stroke impacts on mood and social circumstance not just on physical systems • Emotional wellbeing can impact upon physical recovery • Effect not always apparent in acute stage • Early intervention can improve longer term outcomes

4. How things were 12 months ago • HADS tool (hospital anxiety and depression score) and SADQ-10 (stroke aphasic depression tool) • Assessed at 14 days • Over 60% patients discharged before 14 days • Poor uptake by nursing staff • Carried out by OT’s – reactive and not proactive • Not an ideal tool for acute patients, or patients with aphasia or cognitive impairment • Poor data collection

5. How things were 12 months ago Referrals to psychology service: • Hit and miss • Limited service in acute care • No documented process for nursing staff • Urgent referrals were ad hoc • Non urgent referrals not seen until discharged into the community

6. Review of pathway • Identified need to review current pathway for emotional wellbeing in acute care • Appointment of an additional psychologist • Allocated weekly sessions by on acute ward • Able to see patients on ward • Liaise with nurses, doctors, physiotherapists, OT’s & SLT • Provide training and support for staff • Questionnaire undertaken by staff about perception of emotional wellbeing

7. Staff Questionnaire • All recognised that emotional wellbeing was important • Only 40% patients were asked about their emotional wellbeing • Main barriers to asking patients about emotional wellbeing were • Communication • Experience, knowledge and confidence • Workload

8. Inpatient Emotional Wellbeing Pathway

9. Depression Intensity Scale (DISC) Score of 5 or 6 request Distress Thermometer assessment by OT

10. Stroke Aphasic Depression Questionnaire (SADQ) Score 14-25 - Distress thermometer assessment Score 25-30 - refer to Clinical Psychologist

11. Distress Thermometer

12. Implementation • 6 mths funding from the BCCN for 0.6 WTE psychology assistant • Consulted with staff to adapt the tool • Training sessions with staff • Assistant psychologist ward based to help with • Implementation • Prompt staff • Minor interventions • Collect data and monitor progress • Weekly support for the psychology assistant

13. How it works in practice • Nurses carry out DISCS & SADQ-10 on day 5 • Patient reassessed weekly • If patient triggers then OT completed distress thermometer or seen by psychology assistant • Referral to psychologist if needed for assessment, intervention and follow up • Psychology assistant attends weekly MDT patient reviews • Data collected on stroke register and psychology data base, will then be able to input data on SNAP at 6 mths

14. Evaluation • Repeat staff questionnaire in October (at 6 mths) • Numbers screened • Reasons for not screening • Number of referrals to psychologist • Appropriateness of referrals • Patient questionnaire in January 2013

15. Future • Funding extended for a further 6 mths • Results of evaluation • Adapt tools and pathway if necessary • Develop nurse link worker • Develop the cognitive screening pathway • Group sessions on ward for patients and carers

16. Any Questions Thank you for listening

17. Contacts Dr. Dominic Crowley: dominic.crowley@walsallhealthcare.nhs.uk Dr Amanda Campbell: amanda.campbell@walsallhealthcare.nhs.uk Sonia Jenkinson: sonia.jenkinson@walsallhealthcare.nhs.uk