shaping a service colin hughes consultant nurse - older people (mental health) chesterfield primary...
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Shaping a service
Colin HughesConsultant Nurse - Older People
(Mental Health)
Chesterfield Primary Care Trust
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Chesterfield Royal Hospital NHS Foundation Trust:
570 acute beds
Walton Hospital
Chesterfield PCT:
104 general intermediate care beds
Total beds = 674
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Do the
‘Who Cares Wins’
calculation:
129 will have depression
89 will have delerium
138 will have dementia
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Consultant Nurse-Older People (Mental Health)
Chesterfield Primary Care Trust 1st December 2004
Clinical and developmental role:to develop a mental health liaison service
for older people with mental health problems in Chesterfield
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NSF for Older People (2001) Standard Four:
Develop clear guidelines for involving specialist mental health services in the care of older people in hospital
Staff should be trained to recognise and manage behavioural problems appropriately
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Health and Social Care Change Agent Team (2004):
Early identification of the mental health problems
Check if already known to the specialist mental health services
Responsive multi-disciplinary liaison services that do not solely rely on consultant-to-consultant referral
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Benefits of providing mental health services into the general hospital setting:
•shortened hospital stays and reduced costs•improved physical functioning•fewer nursing home transfers•increased recognition of depression•increased use of community services after discharge•positive effects on outcomes for the treatment of depression and delirium, and for the prevention of delirium
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Consultation Liaison
General hospital staff refer a patient to the mental health service; a member of the service (usually a doctor) provides an assessment and advice, then leaves. Patients may be reviewed.
Direct patient work involves more intensive involvement.The liaison service is more accessible, can respond quickly and review patients more often.Liaison is more proactive involving:awareness raising of the profile of mental health issues,collaborating in shared care through joint meetings,developing education and training programmes.
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Advantages for the liaison model over the traditional consultation models:
•referrals being more appropriate•more accurate diagnosis by referrers•increased referrals•more referrals for depression•reduced waiting time for assessment leading to increased satisfaction for the referrer•more patient contact•better adherence to recommendations•better outcomes in some circumstances
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Benefits in providing mental health services along the lines of a liaison model:
•to referrers (e.g. increased satisfaction)
•to patients (e.g. treatment of depression) •to hospitals (e.g. shortened hospital stays and reduced costs)
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Who does mental health
consultation-liaison in Chesterfield?
• psychiatrists
• clinical psychologists
• mental health nurses
• occupational therapists
• community mental health teams
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Some ideas to start with:
• build on current provision
• add something
• don’t disrupt current processes
• current activity should continue
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Fully multidisciplinary team,all with designated sessions to liaison:The Hospital Mental Health Team
Partly multidisciplinary team, some with dedicated sessions to liaison: an enhanced sector model
Nursing liaison service, dedicated sessions
Medical liaison service, dedicated sessions
Standard sector based consultation service: no dedicated sessions
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Option 1
Develop a nursing liaison service
• Consultant Nurse expertise
• dedicated time, rapid response
• demonstrate nurse led services
BUT
• replacing ‘like with like’
• need medical support
• isolation
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Option 2
Start to develop the idea of a multidisciplinary mental health liaison
service
• partnership with Mental Health Trust
• enhanced sector model but Consultant Nurse is different
• change from the current consultation model to a liaison model
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But where to start?
• work in partnership as a team with the medical psychiatric staff of Derbyshire Mental Health Services NHS Trust
• single point of entry for referrals to enhanced service
• same telephone numbers as previously
• Consultant Nurse leads change:
consultation to liaison
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REFERRALS IN 1 YEAR BY SPECIALTY AT CRH
142
1629
5 20
20
40
60
80
100
120
140
160
Medical Surgical Orthopaedic EMU Gynaecology
T = 194
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REFERRALS IN 1 YEAR BY WARD AT WALTON
28
23
14
22
0
5
10
15
20
25
30
Amber Derwent Haddon Hardwick
T = 87
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Referral and allocation
Referral from general ward phoned through to Barwise
Administration staff at Barwise take referral information and complete referral form
Consultant Nurse (or consultant psychiatrist in his/her absence) triages referrals daily
For urgent referrals administration staff will contact most appropriate and available member of service for action
Consultant Nurse allocates referrals to members of the service following discussion with the consultant psychiatrist as needed
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Liaison activities
• awareness raising of the profile of mental health issues
• undertaking training needs analysis• developing education and training programmes• collaborating in shared care through joint
development meetings or participation in ward rounds
• development of protocols for detection, management and referral of mental health problems in older people
• follow up and tracking of particular patients as indicated
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Evaluation
• the development of a case register database• audit of referrals before and after Consultant Nurse
clinical involvement by number, source and reason for referral
• tracking of a sample of patients to record: where discharged to; re-admissions and reason for re-admissions; physical and mental state
• examination of the views of nursing, therapy and medical staff
• development of patient and relative satisfaction measures
• examination of the operationalisation of the structure and processes of the service