Introducing a children’s health smartphone app at Walsall Healthcare NHS Trust

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Image: publicdomainpictures.net

Leading change

Working across different clinical and non-clinical disciplines, paediatric nurses and a paediatric consultant collaborated with the patient experience team at Walsall Healthcare NHS Trust to lead on the development and implementation of a children’s health smartphone application (App) for staff, patients, their families and carers. This has significantly improved patient, carer and family experience as well as better use of resources locally.

Where to look

The paediatric team identified when shadowing patients on the children’s ward that at times parents and carers expressed worry or confusion due to not having the right information available to them at a time it was needed most. The nurses identified unwarranted variation in the use of information on the Trust’s website, as well as in the knowledge of families as to where to find the information to prepare them for their stay on the ward.

What to change

Feedback was gathered from ward staff caring for patients and their families, as well as from patients and families themselves. This demonstrated that often there was a lack of knowledge of the hospitals processes, which made them feel disempowered, and there were gaps in the information available about hospital visits, procedures and investigations via the resources they were using. Feedback indicated that it was difficult to find information on the Trust’s website, it was not always up-to-date and the website did not work well on different mobile devices. It was identified that patients and families wanted to see information prior to their visit, whilst they were in the hospital and afterwards when discharged home.

The paediatric team identified that a digital application was the most suitable, secure solution to address the unwarranted variation seen in practice and was a cost and resource effective solution, which could be free and easily accessible to patients and families whilst providing information to improve their experience of the department and hospital.

Link to article here

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Mental capacity and ‘best interest’ planning at North Staffordshire Combined Healthcare NHS Trust

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Leading change

The Senior Social Worker and Nursing Clinical Lead in the Staying Home Team, Stoke City Council and North Staffordshire Combined Healthcare NHS Trust (NSCHT) have with the full active involvement of the team redesigned and implemented a new ‘best interests’ decision-making process. This new process has led to improved outcomes, experiences and use of resources within the team, whilst also demonstrating leadership in change and commitment to high quality care provision.

Where to look

North Staffordshire Combined Healthcare NHS Trust (NSCHT) is a provider of mental health, social care and learning disability services in the West Midlands. The team at Marrow House Assessment and Therapy Unit provide dementia assessments in care homes and in the community to some of the most vulnerable adults locally. This includes providing access to specialist information, support and advice, specialist bed-based and community reablement/therapy services, short break services, and early and timely intervention to help reduce risk of crises.

The Mental Capacity Act (2005) empowers people to make decisions for themselves wherever possible, and protect people who lack capacity by providing a flexible framework that places individuals at the very heart of the decision-making process.

Someone may lack mental capacity due to having had a stroke or brain injury, having a  mental health problem, dementia, learning disability or acute confusion, drowsiness or unconsciousness because of an illness or the treatment for it. In these situations, there is a need to ensure individuals can participate as much as possible in any decisions made on their behalf, and that these decisions are made in their best interests. The Mental Capacity Act (2005) code of practice provides a clear ‘checklist’ for those trying to work out an individual’s best interests, including which steps need to be taken under the law to identify all the issues that would be most relevant to the individual who lacks capacity for each decision.

The Senior Social Worker and clinical lead identified that the quality of mental capacity and best interest assessments met the standard required under legislation, however there was unwarranted variation in how these assessments were conducted and the process wasn’t streamlined; there was room for improvement which would also align to proposed changes in the guidance soon. The Senior Social Worker and nursing clinical lead led a programme of work to redesign the procedure for ‘Best Interest support and planning for service users’, to ensure the needs of service users admitted to the service were identified and supported early in the assessment process.

What to change

A full review of the ‘best interests’ assessment process was reviewed by the multidisciplinary team with challenges and opportunities highlighted. The team also identified opportunities to develop the skill sets within the team through additional education and training to support changes in the assessment process.

The senior social worker and clinical nursing lead at NSCHT identified an increase in complexity of people referred into the Assessment and Therapy Unit which had begun to shift the ‘normal’ service provision to a more intensive 24-hour care and support service. As a result, unwarranted variation in practice regarding mental capacity assessments and best interest decisions including involvement of service users, families and carers was evident across the team.

A deep dive review of the team’s activity and performance over the preceding 6 months of practice revealed potential improvements in:

  • Knowledge;
  • Co-ordination of capacity assessments;
  • Deprivation of Liberty Safeguards (DoLS);
  • Best interest planning to include families and carers.

Link to article page here

Improving mentorship at North Staffordshire Combined Healthcare NHS Trust

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Image: Google Images, copyright free

Leading change

The Practice, Education and Preceptorship Lead Nurse at North Staffordshire Combined Healthcare NHS Trust led on the development and implementation of a programme to improve mentorship within the organisation. This programme has shown a variety of improvements including enhanced patient care and experience, more confident students, nurses & Allied Health Partners (AHPs) and increased staff satisfaction and morale.

Where to look

North Staffordshire Combined Healthcare NHS Trust is a provider of mental health, social care and learning disability services in the West Midlands. The Practice Education Team facilitates, develops and supports clinical placements for non-medical students within the Trust and provides professional development support for Trust staff. The team work across the organisation, with other NHS Trusts and with local universities to support the development of the future workforce for the local health economy and to promote the sharing of best practice.

The Practice, Education and Preceptorship lead nurse identified through existing Mentors and Practice Educators that they received little feedback or support for the mentorship they provided which was introducing unwarranted variation in the mentoring offered and on display. To address this unwarranted variation in practice, a programme of work was developed to better inform and support mentors and practice educators of guidance, improve feedback on the provision of practice-based learning and support visible recognition of their role.

Students on Nursing and Midwifery Council (NMC) approved pre-registration nursing education programmes must be supported and assessed by mentors. Mentors are responsible and accountable for:

  • Organising and co-ordinating student learning activities in practice;
  • Supervising students in learning situations and providing them with constructive feedback on their achievements;
  • Setting and monitoring achievement of realistic learning objectives;
  • Assessing total performance – including skills, attitudes and behaviours;
  • Liaising with others (e.g. mentors, sign-off mentors, practice facilitators, practice teachers, personal tutors, programme leaders) to provide feedback, identify any concerns about performance and agree action as appropriate;
  • Providing evidence for, or acting as, sign-off mentors – making decisions about achievement of proficiency at the end of a programme.

In order to do this, mentors need to ensure environments in which practice-based learning takes place is safe and supportive for learners as well as service users, so feedback and support is crucial (Health & Care Professions Council Education Standards, 2017).

What to change

The nurse lead in the Practice Education Team collated feedback from mentors and practice educators. A programme of work was developed and agreed with senior nursing and AHP managers within the Trust and this included a new programme of education and training for staff, additional resources for support and supportive forums, events and networks to ensure mentors feel valued. The programme aimed to:

  • Increase support available to the mentors;
  • Increase visibility in clinical areas of leads;
  • Be the central point of contact for mentors & students;
  • Improve communication;
  • Address unwarranted variation in practice;
  • Develop strengths and celebrate them;
  • Increase the number of AHP students the Trust was mentoring.

Link to article page here

Improving care in mental health services – an acute care pathway

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Image: Picpedia

Leading change

The ward manager at Harplands Hospital, Stoke-on-Trent led on the development and implementation of an Acute Care Pathway (ACP) programme of work to foster new ways of working, standardise good practice and improve experiences for both staff and patients within the Trust. This programme of work has led to both improvements in outcomes and use of resources.

Where to look

The Care Quality Commission (2017) reported that more people than ever are receiving treatment and care for mental health conditions; in part due to a reduction in the stigma associated with mental ill-health. Treatment can only truly succeed if it is supported by mental health service provision that gives people the help they need, when they need it, where they need it (Care Quality Commission 2017). Supporting this, the Five Year Forward View for Mental Health (NHS England 2017) highlights the need to move towards a future where people have access to high-quality care close to home, and they are able to exercise choice – reflecting true shared decision making and personalised care.

The ward manager identified unwarranted variation in the higher than expected incident rates, staff sickness rates, staff vacancies and enhanced observations of patients who were awaiting mental health support.

What to change

The ward manager worked collaboratively with the ward team to review current practices and establish areas for improvement. Through discussion some key elements of improvement were developed, which included a review of:

  • The use of clinical observation to support effective patient care;
  • Patient safety incidents to identify risks and potential opportunities for change;
  • Bed occupancy to identify opportunities to support patients to have a better service and experience;
  • Ways of working to support staff in delivering care, developing a culture of encouraging new staff to join the ward and have a good working experience;
  • Patient experience feedback to identify areas for improvement or change;
  • How the ward works in collaboration with partners across the acute wards and the community partners, identifying areas for improvement and change.

Link to article page here

The Sudden and Unexpected Deaths in Childhood (SUDC) Service – a nurse-led model of care and support

Leading change

The Lead Sudden and Unexpected Deaths in Childhood (SUDC) nurse at Lancashire Care NHS Foundation Trust (LCFT) led on improvements to the nurse-led SUDC Service in collaboration with partner agencies. This service has led to improved outcomes, experiences and use of resources locally.

Where to look

The SUDC Service leads on the implementation and co-ordination of the Rapid Response processes following the unexpected death of a child. It is a national process, outlined in statutory guidance, undertaken by local services (Cabinet Office, 2018). The Child Death Review, Statutory and Operational Guidance in England states that the death of a child is a devastating loss that profoundly affects bereaved parents as well as siblings, grandparents, extended family, friends and professionals who were involved in caring for the child. It recommends that families should be met with empathy and compassion through clear and sensitive communication. Following an unexpected death, there are formal investigations to find the cause of death as part of wider integrated child death review processes (Garstang et al., 2014). These processes have a clear aim of establishing the cause of death, but it is less clear how bereaved families are supported.

In 2016, the Lancashire Child Death Overview Panel (CDOP) commissioned a review of the pan-Lancashire SUDC Service. The review found that two thirds of the child deaths locally occurred out of hours which meant that a full multi-agency response to an unexpected child death wasn’t consistently being undertaken. The findings highlighted that during ‘out of hours’ times, a collective understanding of the circumstances surrounding the death of a child was compromised as there was a reduced consistency in the response from nurse leadership. In addition, the quality of health support and provision of services to families was inequitable. The pan-Lancashire Lead SUDC Nurse identified an opportunity to address the unwarranted variation in ‘out-of-hours’ processes seen in practice, to strengthen and support these services.

What to change

The investigation following an unexpected child death involves the Police, a lead health professional, a Pathologist and the Coroner, all of whom liaise with multi-agency partners as part of the investigation. All professionals involved with child deaths should ensure that procedures are in place to support parents; to allow them to say goodbye to their child, to be able to understand why their child died and to offer the parents follow-up appointments with appropriate health-care professionals (Garstang et al, 2014).

The insight gained from the multi-agency response to any child death, endeavours to influence service design; provision and planning of services; improve practice, support, knowledge and expertise around caring for a child in death, care for the family; and help to identify themes and trends that can be translated into prevention strategies and Public Health messages/initiatives to work towards a reduction in the incidence of child death across Lancashire and nationally.

The lead SUDC nurse identified unwarranted variation in the Lancashire SUDC review regarding the access families had to the SUDC nurses who provided support and information to them throughout the process. The review also highlighted that, if the SUDC nurses were not present at the time of the child’s death, specific health and safeguarding details pertaining to the case were either not gathered, or were minimally gathered. Those families whose children died out of hours sometimes did not meet the SUDC nurses for some 3-4 days following the death of their child. By which time they often did want to engage with the SUDC nurse due to lack of understanding of their role. Thus, some families received a reduced service.

In Lancashire, a nurse-led model is implemented, and it was jointly agreed by the three pan-Lancashire Safeguarding Children’s Boards (LSCBs) to continue this, with CCG funding to expand the nurse-led service to a seven-day service. The aim being, through providing strong nurse leadership, and working closely with the Police and partner agencies, unwarranted variation would be reduced and standards met.

Link to article page here

Good rostering guide – BMA / NHS Employers

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This resource is a result of collaborative working between NHS Employers and the British Medical Association. It is general guidance that sets out the ways in which good rostering practice can be used to develop effective rotas

As part of the Acas-facilitated negotiations in 2016, a commitment was made by NHS Employers and the British Medical Association (BMA) to collaboratively develop good rostering guidance to support employers and doctors.

The guide sets out ways in which good rostering practice can be used to develop rotas. It aims to support and create an effective training environment that also meets the needs of the service, while enabling flexibility for doctors and employers, both of whom have a stake in the process.

The guide covers:

  • key principles of good rostering under the junior doctor contract
  • roster design
  • roster management
  • managing leave requests in rotas, rosters and work schedules for doctors in training
  • non-resident on- call rotas
  • good rota design and rostering recommendations for less than full time (LTFT) doctors.

Link to guide here