care adjustments in hospital: better care healthier lives for people with intellectual disabilities....
TRANSCRIPT
Care Adjustments in Hospital:Better Care Healthier Lives for People
with Intellectual Disabilities.
www.gosh.nhs.uk/intellectual-learning-disability
This is my
Hospital Passport
For people with learning disabilities coming into hospital
My name is: I like to be called:
If I have to go to hospital this book needs to go with me, it gives hospital staff important information about me.
It needs to hang on the end of my bed and a copy should be put in my notes.
This passport belongs to me. Please return it when I am discharged.
Nursing and medical staff please look at my passport before you do any interventions with me.
Things you must know about me
Things that are important to me
My likes and dislikes
Mental Capacity Act 2005 If I am assessed as lacking the capacity to consent to my treatment the following people must be involved in
best interest’s decision making Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details
My Photo
Things you must know about me
Name:
Likes to be known as:
NHS number:
Date of Birth:
Address:
Tel No:
How I communicate – e.g. What language I speak / Equipment / Signs / Photos / Symbols I use:
Family contact person, carer or other support:
Relationship e.g. Mum, Dad, Home Manager, Support Worker:
Address:
Tel No:
My support needs and who gives me the most support:
My carer speaks:
Date completed by 1
Hospitals can be scary places..
The focus will be on:
•Practical solutions to challenging problems•Thinking differently acting creatively•Alert flagging systems•Reasonable adjustments – core and bespoke- how they improve care•Collaborative partnerships
The focus will be on:• Link Leads for ID within hospital and
community across divisions and disciplines
• Engaging Experts by Lived Experience
• Education and training
• Supervision of staff
• Making LD Nursing in hospital a success
It’s MY life
About 25 people with learning disabilities die each week from causes of death wholly or partly amenable to good quality healthcare.
3 people each day
Professors Glover and Emerson of the Improving Health and Lives Learning Disabilities Observatory Using data drawn from the Confidential Inquiry
My Role Together we can get it right
• Specialist advice for people with learning disability who may also have autism
• Assist with complex decisions• Assessment of capacity• Make reasonable adjustments• Expert guidance• Manage difficult situations• Second opinion• Build on existing work
My Role
• Provide 2nd Opinion• Lead on aspects of care• Challenge poor practice in real time• Education in action• Band 6 or 7 liaison post - seek to influence
change in practice by asking for RAs, tests, investigations, modeling good practice
• Consultant level – request and expect = a decision maker
Everybody’s Life Has Worth
• Beware of missing serious illness
• Find the best way to communicate
• Make reasonable adjustments
• Rely more on visual information
• Give more time for processing
Practical Solutions to
Challenging Problems
Learning Disability Alerts Over 850 on system
• Prepare for a person coming in• Make care adjustments• Monitor outcomes and experiences• Improve care
Reasonable Adjustments
This is my
Hospital Passport
For people with learning disabilities coming into hospital
My name is: I like to be called:
If I have to go to hospital this book needs to go with me, it gives hospital staff important information about me.
It needs to hang on the end of my bed and a copy should be put in my notes.
This passport belongs to me. Please return it when I am discharged.
Nursing and medical staff please look at my passport before you do any interventions with me.
Things you must know about me
Things that are important to me
My likes and dislikes
Mental Capacity Act 2005 If I am assessed as lacking the capacity to consent to my treatment the following people must be involved in
best interest’s decision making Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details
My Photo
Things you must know about me
Name:
Likes to be known as:
NHS number:
Date of Birth:
Address:
Tel No:
How I communicate – e.g. What language I speak / Equipment / Signs / Photos / Symbols I use:
Family contact person, carer or other support:
Relationship e.g. Mum, Dad, Home Manager, Support Worker:
Address:
Tel No:
My support needs and who gives me the most support:
My carer speaks:
Date completed by 1
How the passport changes careHow the passport changes care
• Filled in by people with learning disabilities and their supporter’s
• Provides a complete view of the person• Not just about ill health• Owned by the individual• Personalises and dignifies care• Enhances patient safety by providing information
about a person who may not otherwise be able to tell health professionals
Adjusting Care -Think Differently ACT Creatively
• Double appointments• Environmental changes e.g. dimmer switches,
videos• Clinics on Saturdays• Learning disability specific clinics• Health checks and patient held records• Flexible appointment times• No fixed visiting times• Minimising waiting• Increasing support for the person
A picture can say more than words
Books Beyond Words- helping people understand what is happening in their health and in their lives www.booksbeyondwords.co.uk
Enhancing care and experiences
This is my
Hospital Passport
For people with learning disabilities coming into hospital
My name is: I like to be called:
If I have to go to hospital this book needs to go with me, it gives hospital staff important information about me.
It needs to hang on the end of my bed and a copy should be put in my notes.
This passport belongs to me. Please return it when I am discharged.
Nursing and medical staff please look at my passport before you do any interventions with me.
Things you must know about me
Things that are important to me
My likes and dislikes
Mental Capacity Act 2005 If I am assessed as lacking the capacity to consent to my treatment the following people must be involved in
best interest’s decision making Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details
My Photo
Learning Disability Link Leads within the Community and
Hospital
LD Link Leads –across the hospital and community
• Rolling out of learning disability initiatives across the services
• Monitoring, evaluating and changing services through reasonable adjustments
• Providing colleagues with updates
• Assisting in prevention, admission and discharge to reduce re admissions
Engaging Experts by Lived Experience
Experts by Lived Experiences
• Engage people with LD and families in service design, accreditation, delivery, evaluation, evolution and staff training
• THEN we will get it the culture and care right
Being involved –Experts by lived experience
• Be on Committees
• Improve accessible information
• Educate and train staff
• Plan, develop and evaluate service developments and changes
• Be involved in research that leads to practical solutions / change
Collaborative Partnerships
Partnerships - Making an impact
• Other organisations across sectors
• Trial and share information
• Shaping practice together
• Creating models that work
• Being flexible less protective of ideas / concepts
• INNOVATION – BE CREATIVE
Education• In action in real time
• Specific issues faced by people with learning disabilities and their families
• Reasonable adjustments
• Diagnostic Overshadowing
• Assessing a person’s understanding and capacity to consent to treatment
• Communicating without words
• Post qualifying courses
From here to where?
Making Learning Disability Nursing a success in Hospital
• Pre reg and post reg training
• Clear vision and plan
• Achievable outcomes
• Community and hospital buy in
• Clinical supervision
• Voice on the Board
• Commitment from commissioners
Core principles underpinning Intellectual (Learning) Disability work
The following forms the foundation of the way Great Ormond Street Hospital delivers care to and with people with learning disabilities and their families.
1. Value driven - children / young adults can contribute to their care
2. Positive communication - increase the use of positive terminology and place an emphasis on appropriate communication
3. Appreciate the interaction - between the individual and their environment. Understand the child's life experiences and how they express themselves
4. Increase independence - while acknowledging the stage or age of a child it is important to focus on developing the child or young person's independence
5. Promote emotional literacy - ensure that children and young people have opportunities to express themselves and help and support them to understand their own feelings
6. Create a positive environment - welcoming setting - it is important to acknowledge each child's individuality, culture and life experience so that they are valued and important members of the hospital community
7. Focus on individual support - each person is an individual and will respond to positively being addressed by their name and if the service takes into account their needs rather than merely those of a group
8. Work towards achievable goals - set goals that motivate and are achievable within a timescale that is reasonable for that child and or for the service they are using
For more information and advice www.gosh.nhs.uk/intellectual-learning-disability
The Learning Disability Protocol for Preparation for Theatre and Recovery
•Discuss the patient's needs with them and their family/carers.
•Use ‘comforters’ to relax the patient pre op and in recovery .
•Document and handover to colleagues.
•Lower levels of noise and light•Place the patient in a quiet area within recovery •Ensure parents/carers are present and involved.•Gradually recover observing how the patient is progressing If the patient is disturbed or distressed in Recovery:1. Call an anaesthetist to use sedation to induce a relaxed, sleepier state.2. Increase levels of sedation as required.
Recoverpatients with learning
disabilities slowerthan those without one
For more information and advice www.gosh.nhs.uk/intellectual-learning-disability
Influencing change Making an impact• LD Alerts• Education in action• Audits How many people on your ward have a learning disability? • Leadership in decision making / clinical practice
• Networks in service and beyond
• Conferences – Good Practice Events
• Think differently beyond learning disabilities
• Engage staff to create own care adjustments in their settings
• ““It is no use saying, It is no use saying, ‘We are ‘We are
doing our best’doing our best’ YouYou havehave got to succeed in doing got to succeed in doing what is necessary.”what is necessary.”
• Winston ChurchillWinston Churchill
Online accessible health information for people with autism and or learning disabilities