Liverpool Heart and Chest NHS Foundation Trust

The Development of a Nursing Model of Care for Patient and Family Centred Care

Liverpool Heart and Chest NHS Foundation Trust

Liverpool Heart and Chest Hospital became a NHS Foundation Trust in December 2009 and provides heart and chest services for the North West of England, including North Wales and the Isle of Man. Each year they perform 60,000 Outpatient appointments and 12,000 inpatient procedures covering: Cardiology, Heart Surgery, Thoracic Surgery, Upper Gastrointestinal Surgery, Respiratory Medicine (including Adult Cystic Fibrosis) and Cancer Services. This case study was the overall winner in the PEN National Award 2013

Aim – The aim of the initiative was to improve the care experience of patients and families, testing out a number of work-streams:

Care partners: optimise the involvement of families in delivering and supporting patient care. Involvement includes communication and education, providing emotional and spiritual support, physical care e.g. giving drinks or hygiene needs and safety advocate.

Patient & Family Centred Care (PFCC) handovers: to involve the patient and family as communication partners at the handover, on transfer, from the critical environment to a surgical ward.

Care Contract: empowering and engaging patients and families to work in partnership with healthcare staff. This is a tool to engage patients, families and staff to discuss patient preferences and choices and for healthcare staff to deliver key information to support patients in decision making about their care.

Ward rounds: an agreed structure to the scheduling and format of patient and family centred ward rounds to promote effective communication and involvement of the patients and families with the clinical staff.

Healing environment
A new 20-bedded surgical ward designed with patients and families, incorporating a family room, 12 single rooms and two four- bedded bays. It was designed to “feel like a hotel” and comments from patients and their families reflect this. Seven of the twelve individual rooms have a pull down bed for family members to stay with their loved one during what is a most anxious time for them. Other rooms have reclining chairs to maximise comfort for family members.

The outcomes for the project were summarised as follows:
Families are consistently involved in the care of their family member with the support and guidance of the nursing team. Family members are enjoying the new facilities and being able to stay overnight in the patients’ room has resulted in a reduction in anxiety levels of the families.

Easy access for families has created a calm and welcome environment on the ward with families seen as integral to the care team. Families work consistently with staff to support safe and effective care, providing encouragement with mobilisation, hydration and nutrition, education advocate, listening to and supporting the advice of health care team, providing emotional and spiritual care, reading and also as safety advocate ensuring patients have their buzzer and personal possessions at hand.

Staff report how the flow of delivering care is improved throughout the day as the peak visiting times are no longer apparent. Patients are less disturbed by ward activity and are better rested. Patient and family shadowing has demonstrated how reassured they are, that they know how their care is progressing and actively participate in bedside handovers and ward rounds.

For more information contact Louise Blunt at PEN: l.blunt@patientexperiencenetwork.org

Central Manchester University Hospitals NHS Foundation Trust

Promoting High Quality Care and Dignity For All Deceased Persons (Adults) And Their Families

case-study-januar

Central Manchester University Hospitals is a large teaching hospital located in Manchester city centre comprising five specialist hospitals providing health care to a diverse population. It treats more than one million people per year. On average, there are 1200 adult deaths per annum. The Trust adult mortuary also provides a City mortuary service to care for a further 1200 deceased persons who have died in the community.

The death of a person causes distress to the deceased person’s family and loved ones so it is essential to manage all aspects of their care sensitively. Review of local practice highlighted the lack of formal guidelines and policy to support best practice for deceased persons and their families. Standards of care after death were found to differ not only between but also within clinical areas, and the need for change was identified.

The purpose of the initiative was to promote high quality, dignified and standardised care for the deceased person and their family following deaths occurring both within hospital and community settings. During their journey to the adult mortuary with the porters, care within the adult mortuary concluding when the care of the deceased person is transferred to the funeral director.

Current practice within the organisation, including incidents and complaints to capture family/carer and professional feedback was scrutinised together with relevant local and national guidance. Consultation within and beyond the organisation was key to understanding the entire care in a variety of settings as well as to recruit support, and for promotion. A Macmillan Palliative Care Nurse Specialist led a multi-professional policy development group.

A comprehensive new policy with organisational ratification was developed. Supporting documentation was developed incorporating new requirements in addition to those of pre-existing policies. Standardisation of care and the processes to follow was a key driver. The new policy was embedded into organisational practice through a three-month multi-disciplinary education programme delivered by the lead and the End of Life care facilitator.

The initiative has enabled current practice to be challenged and has resulted in a huge organizational change in practice and culture. Clinical practice is now evidence-based with a huge focus on high quality and dignity. Trust staff started to question their own individual practice but also their team’s approach to this aspect of care, having previously delivered care embedded in a ritualistic approach.
As a result of this work, both clinical and non-clinical staff have received training with specific feedback from bereaved families and evidence from national guidance to gain a clearer understanding of the importance and rationale to deliver dignified care. This incorporates the promotion of personal, religious, and cultural wishes in care after death; considering family involvement; and the improvement of communication ensuring consistency in language to maintain quality and dignity. Staff fed back that they had never received formal training in this aspect of care and this has enabled them to reflect on their practice.

The initiative is special as it has given an aspect of care that is so important the opportunity to be high on the Trust agenda. It has challenged opinion and aspects of care that were grounded in tradition and ritual, and has striven to ensure that regardless of which area a person has died in that they will receive high quality and dignified care.

The initiative also provided all Trust staff who care for the deceased person with clear guidance of the process and procedures to follow after a death, and formal, standardised training including staff groups who do not routinely receive such training including porters and administration/clerical staff. Over 600 Trust staff received formal training delivered in small groups to allow interactive teaching in a protected environment.

Professional and carer feedback has been extremely positive, with many staff wishing to support the initiative in the future by becoming champions and contributing in the audit process.

Learning Points

  • Identifying an appropriate lead that is dedicated, passionate, and determined is paramount.
  • Key attributes of members of the working party included commitment and compassion. Collaborative working and elicitation of family and professional views, as well as the incorporation of national guidance is essential.
  • Employment of a variety of promotional activities as well as ensuring compatibility with the organisation’s ethos/principles is necessary to secure commitment of both clinical and strategic levels within the Trust.
  • The use of real examples from practice within training helped staff understand the real needs of deceased persons and their families and the rationale behind the required care.
  • An awareness of the enormity of such a project is vital; one must be prepared to uncover more areas for consideration than initially anticipated.

Patient and Public Engagement Conference

Friday 7th February 2014, London

The Tavistock and Portman NHS Foundation Trust is hosting a Patient and Public Engagement Conference on Friday 7th February 2014 on behalf of the Mental Health Patient and Public Involvement Forum. The Forum is a network of PPI representatives from all the mental health trusts of Greater London and the Home Counties who meet regularly to learn from each other, share examples of user engagement and speak as a united voice to policymakers to influence change.

The conference is for service users, carers and other professionals who are interested in learning, understanding and developing their thinking and practical skills around providing good practice in mental health settings in relation to service user involvement. Angela Greatley, Chair of the Tavistock and Portman NHS Foundation Trust, will be opening the conference and the day will begin with a talk from Baroness Molly Meacher of Spitalfields on the subject of ‘No Health Without Mental Health’. As well as some stimulating and lively talks throughout the day, there will be some practical workshops available for delegates to attend and to gain some further insight into providing good practice in patient and public involvement. Each workshop will be interactive and encourage delegates to share and discuss their personal experience of service user involvement. The day promises to ensure that service users can genuinely engage with staff in order to properly influence service delivery.

For more information about this conference, please click here to view the conference programme. The conference is free for service users and carers to attend, and £50 for staff and other professionals. Professionals are encouraged to attend with a user.

You can also learn more about the conference and what the day offers by clicking here.

 

Prevention: The DDES Experience

nhs

boehringerelc

PEN Winner

Commissioning for personalisation in stroke prevention: The DDES experience

Made up of 42 GP practices covering southern and eastern County Durham unitary authority, Durham Dales, Easington and Sedgefield (DDES) Clinical Commissioning Group has a registered population of 288,000. GPs and a multidisciplinary leadership team of health professionals are fully responsible for the planning and purchasing (commissioning) local health services.
In January 2012, DDES CCG started working with Boehringer Ingelheim Limited (BI) and the social business GCA Limited to co design a prototype stroke prevention commissioning programme for spread across the UK.

The aim of the programme was to explore and deeply understand peoples’ current experiences of stroke prevention so that DDES can improve personalisation of care and commissioned services and develop a set of sensitive measures to track improvement.

This work consisted of 4 stages:

Developing insight and completing need assessment: DDES engaged commissioners, front line caregivers (NHS, social care and voluntary sector), local people with experience of stroke and stroke prevention and their families in 2 events and undertook 10 semi structured interviews with local people and caregivers to map current stories and experiences of stroke prevention and desired ones. This threw up anomalies about how care givers and people/families see the world and a set of improvement challenges around personalisation. Most notable was the contrasting professional/patient and family experience of ‘hearing diagnosis and early support’. DDES data was then benchmarked with National ELC™ insights and then triangulated to provide a comprehensive health needs assessment.

Service specification: the co design process continued with two full day events. The first applied PATH planning. Local people worked with commissioners/caregivers to co design ‘great stroke prevention care in three years time’ and a detailed route map. The second brought stakeholders together to co design solutions to the 12 most critical improvement challenges and develop a three year strategy.

Improvement contract co design: current providers, local people, providers and commissioners co designed an improvement contract framework, including: a shared ‘purpose’ and a set of person centred values to drive commissioning/service delivery; outcome measures that all providers – including voluntary sector, lifestyle services, GP, pharmacy and NHS trust providers – will be held to account for and that can underpin an integrated ‘alliance contract’ for personalised stroke prevention care.

Key improvements:

  • Improving family and personal experience of hearing diagnosis and early signposting peer support ( largely in general practice) to accelerate restoration of peoples’ confidence and ability to reduce their risk and improve their lives independently (what they want);
  • Systematising primary care screening and follow up in high risk people;
  • Commissioning an integrated ‘connection’ experience in the form of an invigorated, more focused network of peer led support groups (mainly voluntary sector) for people with risk factors for hypertension, stroke, including CVD, diabetes, AF and TIA
  • Commissioning personalised exercise programmes that build confidence in the person AND their spouse to keep exercising as they did prior to diagnosis
  • Integrating pharmacy commissioning to deliver ‘confidence about managing my medicines’
  • Educating caregivers so they empathise with people and better understand how stroke prevention impacts on people and family lives

Educating ‘gatekeepers’ (GP receptionists, out of hours, A&E) about stroke symptoms so they accelerate access to diagnosis and treatment.

DDES deeply understands the improvement challenge and can commission the right services and measure the outcomes that matter. The work was endorsed by DDES CCG’s authorisation team.

Learning Points:

  • Stroke prevention, diabetes and cardiovascular disease prevention have much in common. We can rationalise experience led commissioning around these agendas
  • Clinicians grossly underestimate the impact of TIA and AF on people lives. People tell us ‘it feels like you are dying’. Clinicians say, ‘It won’t kill you’. When a clinician has first hand or close family member experience of living with these conditions, their attitude quickly changes and they deliver more empathetic care
  • Peoples’ experience of hearing diagnosis and early support to come to terms with and adjust to a new way of living can either accelerate their ability to self care and prevent stroke or leave them feeling disempowered, anxious, scared, helpless and with no confidence to take action. Confidence is essence of what people need to feel to improve stroke prevention outcomes
  • Peer support and being connected with people who share the same experience is a great comfort and vastly undervalued by health commissioners. In stroke prevention, which largely relies on self care, it is as important as clinical care.
  • Front line care givers and people alike find participation in ELC™ co design events is a learning experience.

Commissioning can be inspiring, fun and educational!

9th Annual Patient Information Conference – Patient Information Forum (PiF)

We are delighted to announce that the 9th Annual Patient Information Conference will take place at the St John’s Hotel, Solihull, on Thursday 1st May 2014.

Registrations are now open and the first Early Bird discount of 20% will until be valid until close of play on 20th December 2013.

The PiF annual conference is all about the fundamental components of delivering high quality health information resources and services, with a look at policy, quality standards and commissioning information. High-level speakers from across voluntary, NHS, and commercial sectors, will bring you up to date with national information strategies, whilst hands-on workshops will develop the core skills behind producing and disseminating quality health information.

Click here to register to attend the conference (remember, if you are a PiF member you must be logged in to the website to see your member-level fee).

This is the conference you must attend in 2014 if you communicate with patients and the public about their health.

Please visit www.pifonline.org.uk for regular updates.

We hope you can join us!

Patient Information Forum (PiF)

500 Chiswick High Road, London W4 5RG

Mobile: + 44 (0) 7813 143 384

Email: admin@pifonline.org.uk

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PiF – For Professionals Working in Consumer Health Information