Reducing the CDV risk for people with Serious Mental Health Illness the NTW perspective
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Reducing the CDV risk for people with Serious Mental Health Illness the NTW perspective, by Northumberland, Tyne and Wear NHS Foundation Trust
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Reducing the CDV risk for people with Serious Mental Health Illness the NTW perspective
- 1. Reducing CVD risk for people with Serious Mental Illness the NTW perspective Anne Moore Group Nurse Director - Specialist Care Services Julie Taylor Physical Health Lead Nurse / Project Lead
- 3. Northumberland, Tyne and Wear NHS Foundation Trust • Population of 1.4 m • Six geographical areas • One of the largest mental health and disability organisations in the country • Income of circa £300 m and circa 6,000 staff • Over 130 sites
- 4. CIPOLD – Confidential Enquiry • Median age of death for men with learning disabilities 65 (UK population 78) • For women median age was 63 (UK population 83) • 42% of deaths (238 reviewed) were considered premature. (published by Norah Fry Research Centre, 2013)
- 5. Royal College of Psychiatrists (2014). Trust Level Data for: Northumberland, Tyne and Wear NHS Foundation Trust 2014. London: Healthcare Quality Improvement Partnership National Audit for Schizophrenia 2014 Standard 4 Monitoring Physical Health Risk Factors Total Sample % NTW % FIVE RISK FACTORS (family history excluded) 33 39 SMOKING 89 91 BMI 52 65 GLUCOSE CONTROL 57 58 LIPIDS 57 69 BLOOD PRESSURE 61 75 ALCOHOL CONSUMPTION 70 71 SUBSTANCE MISUSE 89 87
- 6. Standard 5 Intervention Offered for Identified Physical Health Risks Total Sample % NTW % SMOKING 59 47 BMI > or = 25Kg/m2 71 72 ABNORMAL GLUCOSE CONTROL 36 28 ABNORMAL LIPIDS (not reported) ELEVATED BLOOD PRESSURE 25 8 ALCOHOL MISUSE 74 73 SUBSTANCE MISUSE 73 67 Royal College of Psychiatrists (2014). Trust Level Data for: Northumberland, Tyne and Wear NHS Foundation Trust 2014. London: Healthcare Quality Improvement Partnership
- 7. Trust-wide approach to the pursuit of physical health parity What did we do?
- 8. Improving Health Outcomes Physical Health & Wellbeing Group PHWB conferences Physical Health Link Workers & Champions Pilot site - implementing Cardio- vascular health strategiesTransformation Programmes Non-Medical Prescribing Nursing Strategy – ‘Delivering Compassion in Practice’ Trust Policies Monitor Record Communicate
- 9. Physical Health Link Workers and Community Champions • Each ward or clinical team • Qualified lead & associated assistant • 96 initially identified - increased • Attend monthly physical health meetings • Cascade information • First line of physical health training • Support ward level training / awareness
- 10. Physical health skills passport Physical health skills self-assessment
- 11. Two tier physical health skills training: Foundation Advanced
- 12. Some sample topics from the Foundation Course:
- 13. Advanced Physical Health - Skills Lab
- 14. What next?
- 15. Evaluation / outcomes CVD Project report follow-up – cholesterol / BP / glucose Building on CVD Project work – intervention pathways Repeating Skills self assessment post-training Comments box attached – positive statements received Developing strategies for collecting data: • changes in co-morbidities / diagnoses • referrals to GP and / or Secondary care services • deaths related to physical health
Notes de l'éditeur
- Northumberland Bamburgh Castle Newcastle Tyne Bridge North Tyneside St Mary’s lighthouse South Tyneside Marsden rock Gateshead Angel of the North Sunderland Penshaw Monument
- Population of 1.4 million people in the North East of England Six geographical areas of Northumberland, Newcastle, North Tyneside, South Tyneside, Gateshead and Sunderland One of the largest mental health and disability organisations in the country Income of circa £300 million and circa 6,000 staff Over 130 sites and provide a range of comprehensive services including regional and national specialist services
- A number of investigations – such as death by indifference Confidential Enquiry into premature deaths by people with learning disabilities NTW mapped themselves against the 18 recommendations to identify future work, such as developing red flag on RiO and trust-wide consistency regards annual health check reporting.
- Monitoring of physical health risk factors was average in your Trust but this is still below what should be provided
- It was below average for intervention for abnormal blood pressure (Table 2, standards 4 & 5).
- This session will describe Northumberland, Tyne and Wear’s Trust-wide approach to the pursuit of physical health parity. Documents such as the CIPOLD report of the Confidential Inquiry into premature deaths of people with learning disabilities, the NAS and re-audit in 2014 helped to identify gaps in the skills base of our qualified nurses with respect physical health monitoring We will explore the wide-scale introduction of the Physical Health Link Worker role and Physical Health Training programmes to support the implementation of the Lester Tool and associated clinical health pathways for intervention. In line with National guidance on parity of physical health care, NTW extended the processes developed to meet the Learning Disability CQUIN and recent physical health CQUIN, for the benefit of all remaining relevant patients; all inpatient and community services are embedding systems to ensure that every patient has the physical assessments and treatments for the cardio-metabolic conditions that cause premature deaths.
- committed to improving the Physical Health and Wellbeing of its service users many areas of activity and good practice 2012 - developed Trust-wide Physical Health and Wellbeing group, reporting to Trust-wide Quality and Performance Group, prioritise the focus on physical healthcare and the health and wellbeing of Service Users, ensuring that this remains a priority 2014-2019 Nursing Strategy – Delivering Compassion in Practice. 18 page document highlighting Trust plan to strengthen and maximise nurse’s influence on policy development, build capacity, capability and the flexibility to take on new roles and freedoms, lead service change and enable the development and dissemination of best practice not only within the Trust but also on a local, national and international stage. support the nursing workforce to increase their knowledge and skills in order for them to fulfil their potential; by maximising access to principle based, flexibly delivered education and training which will enable them to make the best use of current up to date practice; meeting their personal and professional goals and most importantly, service user needs. Development of Physical Health Skills Passport Trust policies and guidelines reviewed and disseminated to reflect the importance of the need to monitor, record and communicate physical health concerns, whilst understanding when and who should intervene to provide appropriate treatment for that concern. On the 30th of July 2014 and 6th July 2015, the Trust hosted Conferences: Improving Physical Health and Wellbeing: Everybody’s Business. Over 300 staff, many of whom have taken on the role of Physical Health Link Workers in inpatient services and in community services as Health Champions. To support them an extensive physical health training programme commenced in September 2014 and continues to be an integral component of the Trusts Training Programme, including the introduction of the Lester Tool into clinical practice. invested in the development of non-medical prescribing across the Trust, and currently have 53 non-medical prescribers, with more due to start their training later this year; evidence shows that non-medical prescribing improves patient care by ensuring timely access to medicines and treatment, increasing flexibility in accessing clear information and advice on condition progression. Patients can clarify questions they have on medication side effects, dosage calibration and when to administer medicines with non-medical prescribers, to ensure correct medication use and concordance. NTW were successful in being named one of the 4 pilot sites for NHS Improving Quality’s, which aims to identify and prevent cardiovascular disease in people with serious mental illness, ultimately saving lives
- Physical Health Link Workers (inpatient services) and community services Health Champions are a vital part of our commitment to improving the physical health and well being of service users, by supporting the development of their team in relation to health promotion, best practice, preventing adverse effects on health and well being, and reducing health inequalities within their own work environment. They also contribute to the evolution of excellent health related treatment pathways the development, implementation and evaluation of related policies Individual/individuals from each ward or clinical team Qualified lead & associated assistant 96 initially – now 118 inpatient and 80 Health Champions Attend monthly physical health meetings which include a training or awareness component such as effects of smoking and smoking cessation on prescribing, Nutritional Screening Tool assessment based on the ‘Malnutrition Universal Screening Tool’ ‘MUST’ is adapted/reproduced here with the kind permission of BAPEN (British Association of Parenteral and Enteral Nutrition). Cascade / information point First line of physical health training Support ward level training
- Physical Health Skills Passport Documents such as the CIPOLD report of the Confidential Inquiry into premature deaths of people with learning disabilities, the NAS and re-audit in 2014 identified gaps in the skills base of our qualified nurses with respect physical health monitoring The Nursing Strategy highlighted the need for Nurses to develop their skills base in order to reach their own professional needs, using evidence based strategies, but importantly to meet the needs of our service users The Physical Health Skills Passport was designed to enable practitioners to clearly identify the physical health related training they required as well as maintaining evidence of personal skills and recording the training and assessments of competence undertaken. Staff work with their line manager in identifying their own learning needs via a physical health skills self assessment, which incudes skills such as venepuncture, blood glucose monitoring and urinalysis. Review their learning after training events and identify further training needs utilising the Appraisal process to map existing knowledge and plan additional training with line manager. Develop “SMARTER” objectives and goals for implementing their knowledge of health & well being into practice; utilising the Appraisal framework. Arrange opportunities to gain insight into health & well being best practice guidance.
- to support the role of Physical Health Link Worker and Health Champion and the identified training needs of our staff identified through the Physical Health Passport, NTW developed an extensive physical health training programme which continues to be an integral component of the Trusts Training Programme. The initial target audience for the 2 tier training was Physical Health Link Workers and Champions, but it is now being out to all nursing staff with support from the Training and Development department and through localised ‘Train the Trainer’ cascades Advanced Adv – Demonstrate physical health monitoring and corresponding response to changing PH conditions through PH simulations. Focus on factors influencing health - ‘the deteriorating patient’ Underpinning health conditions and importance of homeostasis Understanding / implementation of ‘NEWS’ & national e-learning programme Intervention frameworks and interpretation of results – ‘what do we do?’ Other factors indicating deterioration in health status Demonstrate proficiency in a skills lab environment
- Foundation Foundation- focusses on developing a standardised approach to monitoring and intervening with regards physical health systems. Each session begins by exploring the importance of physical health monitoring and intervention for our patient group, discussing anonymised case examples with supporting evidence from CQUIN, CIPOLD, NAS & NAS2 and the Lester Tool. Focus on understanding body systems (respiratory, cardiovascular etc) Physiological observations needed to assess physical health status – NEWS principles Maps with CQUIN requirements and Lester Tool 2014
- The challenge to deliver continuous and consistent quality patient care requires proper training, accurate assessments, interventions and clinical decision-making skills to ensure the best patient outcomes. simulation-based training allows staff to perform health assessments and interventions, and refine these skills, to ultimately help improve patient outcomes. Advanced Adv – Demonstrate physical health monitoring and corresponding response to changing PH conditions through PH simulations. Focus on factors influencing health - ‘the deteriorating patient’ Underpinning health conditions and importance of homeostasis Understanding / implementation of ‘NEWS’ & national e-learning programme Intervention frameworks and interpretation of results – ‘what do we do?’ Other factors indicating deterioration in health status Demonstrate proficiency in a skills lab environment Feedback is provided during the learning experience Learners engage in repetitive practice Learners practice with increasing levels of difficulty Simulation training is adapted to multiple learning strategies A wide variety of clinical conditions are provided, such as cardio-metabolic issues such as QTc interval changes Learning on the simulator occurs in a controlled environment – skills lab Learning outcomes are clearly defined This intermediate advanced course commenced on the 26th of March and so far 48 people have been trained, and the course has received very positive feedback
- Using data to inform future changes to training and development needs, and to support the evidence for change in relation to Project Work Self assessment to compare with initial one completed prior to training. Follow up with further support from Link Worker or myself – main topic which staff feel de-skilled with is manual blood pressure taking A comments box was added to the self assessment document as a way of capturing comments about the training in order to refresh and update it so it remains appropriate to practice.