making every contact count at united lincolnshire hospitals

Making Every Contact Count at United Lincolnshire HospitalsJennie NegusDeputy Director of Patient Services& MECC Implementation LeadMarch 1st 2013

Our CQUIN targets

AimActionStrategic leadsBoard lead Director of NursingImplementation Lead - DDClinical championsSite based CNSsHead of TherapiesHead of professional developmentIncreased MECC activity & referrals??? Baseline????

TRAININGWard staffSiteCNSB7B6B5B4MedicalTotalPilgrim (PHB)3554001467Lincoln (LCH)6327221499Grantham (GDH)5121501437Therapies75278

Organisational readinessMonitoring of progress

Training

Training plan

ChallengesBaselineHow on earth do we measure?Asking the question part of nursing assessments, therapy assessments, medical clerking.

In the end:Survey crude but something!

RecordingHow on earth do we record?Explored but couldnt add to PAS.Could we audit?How do we keep track on notes?

In the endActivity log not comprehensive but gives a reasonable picture.

Its a busy worldPush the message that not an additional task.

Make the process simple and effective.

Make it beneficial.

Acknowledge already asking.Difference is how & where to access support.

Developed pathway, postcard & MECC sticker.

Feed back re: referrals; help available.

Struggling with diabetes.

Under reporting.

Chart1

333119

551215

0000

295519

Sept

Oct

Nov

Dec

MECC 'encounters' by Team

activity tracker

MonthMECC teamSpecialtySiteWants to make lifestyle changeUnsure wants to make lifestyle changeLifestyle change not wantedReferral / action

Sep-124OTPilgrimReferred to weightwatchers

Sep-124OTPilgrimUnable to refer due to pregnancy; gave advice for post-natal

Sep-121CNSLincolnReferred to weightwatchers

Sep-121CNSLincolnPhoenix smoking cessation

Sep-121CNSLincolnReferral forms given for weight watchers and Phoneix

Sep-122CNSGranthamReferred to exercise on referral


Oct-121CNSLincolnReferred to Phoenix

Oct-121CNSLincolnRefused Phoenix referral but took away information

Oct-121CNSLincolnDiscussed smoking cessation; referral refused.


Oct-121CNSLincolnReferred to pulmonary rehab






Oct-124OTGranthamReferred to occupational health

Oct-124OTGranthamPhoenix number provided



Oct-121CNSLincolnDiscussed exercise

Oct-121CNSLincolnDiscussed Phoenix






Oct-121CNSLincolnDiscussed importance of lifestyle changes




Oct-122CNSGranthamReferred to exercise on referral

Oct-122CNSGranthamReferred to Phoenix

Oct-122CNSGranthamReferred to Phoenix weight management



Oct-124OTPilgrimReferred to weightwatchers

Oct-124OTPilgrimWants to improve exercise tolerance but does not feel ready for referral.

Oct-124OTPilgrimHad conversaiton but declined referral.

Dec-124DieteticsLincolnReferred to weightwatchers

Nov-121CNSGranthamReferred to Phoenix

Nov-121CNSGranthamReferred to Phoenixdaughter of patient above who attended as well

Nov-121CNSGrantham

Nov-121CNSGranthamHas stopped before, info given

Oct-124PhysioPilgrimrefused Phoenix

Nov-124PhysioPilgrimTo think about it and ask GP if wants referral

Nov-124PhysioPilgrimDoes not feel any use as will increase wt if stops smoking

Nov-124PhysioPilgrimTo consider in future

Nov-124PhysioPilgrimTo discuss at next appt

Nov-124PhysioPilgrimNeeds time to think as has failed to stop smoking in past

Nov-124PhysioPilgrimreferred to Phoenix

Nov-124DieteticsLincolnExercise referral in place

Nov-124DieteticsLincoln

Nov-124DieteticsLincolnExercise referral made


Dec-124DieteticsLincolnExercise referral given to patient to read at home

Dec-124DieteticsLincoln

Nov-124DieteticsLincolnReferral to addaction

Nov-124DieteticsLincolnPt own initiative


Nov-124DieteticsLincolnInfo on alcohol limits given



Nov-124DieteticsLincolnInformation given




Nov-124DieteticsLincolnPhoenix info given as in-pt

Nov-124DieteticsLincolnPhoenix info given








Nov-124DieteticsLincolnInformation given on consequences



Nov-124DieteticsLincolnExercise referral




Dec-124DieteticsLincolnRefused Phoenix referral

Dec-124DieteticsLincolnInfo on alcohol limits given

Dec-124DieteticsLincolnDiscused exercise, pt has joined gym

Dec-124DieteticsLincolnDiscussed wt management & encouraged


Nov-124DieteticsGranthamDiscussed exercise referrals

Nov-124DieteticsGranthamExercise referral

Nov-124DieteticsGranthamTo discuss with GP

Nov-124DieteticsGranthamPhoenix referral

Nov-124DieteticsGranthamTo discuss with medical staff

Nov-124DieteticsGranthamInformation given

Nov-124DieteticsGranthamReferred to weightwatchers

Nov-124OTPilgrim

Nov-124OTPilgrimAdvised to see GP if changes mind

Nov-124OTPilgrim

Nov-124OTPilgrimDeclined referral

Nov-124OTPilgrim


Oct-124OTPilgrimReferred to DART

Oct-124OTPilgrimAdvised to see GP if changes mind

Oct-124OTPilgrimDiscussed alcohol reduction; refused referral

Nov-124OTPilgrimReferred for reading help




Nov-124OTPilgrimreferred for falls support at home

Nov-121CNSLincolnReferred Phoenix & pulmonary rehab

Nov-121CNSLincolnDiscussed importance of smoking cessation

Nov-121CNSLincolnDiscussed smoking cessation & exercise

Nov-121CNSLincolnReferred dietician, discussed Phoenix, COPD diet information given

Nov-121CNSLincolnDietary advice given, referred dietician

Nov-121CNSLincolnDiscussed Phoneix but refused

Nov-121CNSLincolnAlready attending Phoenice

Dec-121CNSLincolnReferred for vitality classes and COPD rehab


Oct-121CNSLincolnPhoenix information given

Oct-121CNSLincolnDisucssed smoking cessation

Oct-121CNSLincolnDiscussed importance of lifestyle change



Oct-121CNSLincolnReinforced smoking cessation & exercise importance


Oct-121CNSLincolnDiscussed exercise in asthma


Nov-122CNSGranthamExercise on referral


Nov-122CNSGranthamAdvice and contact details given




Nov-122CNSGranthamReferred Phoenix

Nov-122CNSGranthamExercise referral

Dec-122CNSGranthamReferred weightwatchers

Dec-122CNSGranthamNeeds further surgery.

Dec-122CNSGranthamDetails given for exercise


Dec-122CNSGranthamExercise on referral

Dec-122CNSGranthamDetails & advice given


Dec-124DieticianLincolnReferred weightwatchers

Nov-124OTLincolnExercise referral offered - declined. Provided information on health walks

Dec-124OTLincolnReferred to Lincoln exercise specialist

Dec-124OTLincolnkeen to restart yoga! Information given re: vitality group.

Dec-124OTLincolnReferred for lifestyle support following discussion with consultant.

Dec-124DieticianLincolnReferred to weightwatchers

Dec-121CNSGranthamReferred to Phoenix

Dec-121CNSGranthamDclined Phoenix referral

Dec-121CNSGranthamReferred Phoenix


Dec-121CNSGranthamDiscussed weightloss and exercise but anxious due to injury

Dec-121CNSGranthamTo discuss again in 1/12

Dec-121CNSGranthamPhoenix information given

Dec-121CNSGranthamPhoenix and exercise information given

Dec-122CNSGranthamDietary advice given

Dec-122CNSGranthamWants to discuss smoking cessation with GP

Dec-122CNSGranthamDeclined Phoenix referral


Nov-122CNSGranthamDeclined Phoenix referral

Nov-122CNSGranthamDeclined support



Dec-122CNSGranthamDiet & exercise referrals

Dec-122CNSGranthamDeclined support

Dec-122CNSGranthamGeneral diet & lifestyle discussions & advice


Jan-132CNSGranthamDeclined support

Jan-132CNSGranthamGeneral diet & lifestyle discussions & advice

Dec-124OTGranthamDeclined support

Dec-124OTGranthamInformation provided


Dec-124OTGranthamContact details given



graphs

No of MECC encounters

Team 1Team 2Team 3Team 4

PHBGDHLCHPHBGDHLCHPHBGDHLCHPHBGDHLCH

Sept322

Oct2355

Nov

Dec

Jan

Feb

Mar

State of readiness


ReadyUnsureNot readyReadyUnsureNot readyReadyUnsureNot readyReadyUnsureNot ready

Sept322

Oct67105212

Nov

Dec

Jan

Feb

Mar

No of MECC referrals


Ph'xWWExercOtherPh'xWWExercOtherPh'xWWExercOtherPh'xWWExercOther

Sept12211

Oct5111321

Nov

Dec

Jan

Feb

Mar

graphs

Sept

Oct

No of MECC 'encounters' 2012

Q3

Sept

Oct

Patient 'state of readiness' 2012

Sept

Oct

No of referrals 2012

Sept7

Oct37

Nov58

Dec8

CNS37

Dietician45

OT21

Physio7

GDH20

LCH64

PHB26

Ready56

Unsure24

Not ready30

GP7

Refused support7

Exercise referral11

Phoenix referral23

Alcohol / drug referral7

Weightwatchers referral8

58% of encounters resulted in a referral

1 Resp2 Cardio3 Diab4 Therapy

Sept3502

Oct33509

Nov1112055

Dec915019

GDHPHBLCH

Sept223

Oct7733

Nov231738

Dec29014

MECC activity Q3 2012/2013

MECC activity by clinical role Q3 2012/2013

MECC activity by site Q3 2012/2013

Pt state of readiness Q3 2012/2013

MECC referrals Q3 2012/2013

Sept

Oct

Nov

Dec


Chart1

223

7733

231738

29014

GDH

PHB

LCH

MECC 'encounters' by site

activity tracker













































Nov-121CNSGrantham





















































Nov-124OTPilgrim


Nov-124OTPilgrim


Nov-124OTPilgrim













































































graphs




Sept322

Oct2355

Nov

Dec

Jan

Feb

Mar

State of readiness



Sept322

Oct67105212

Nov

Dec

Jan

Feb

Mar




Sept12211

Oct5111321

Nov

Dec

Jan

Feb

Mar

graphs

Sept

Oct


Q3

Sept

Oct


Sept

Oct


Sept7

Oct37

Nov58

Dec8

CNS37

Dietician45

OT21

Physio7

GDH20

LCH64

PHB26

Ready56

Unsure24

Not ready30

GP7

Refused support7

Exercise referral11

Phoenix referral23





Sept3502

Oct33509

Nov1112055

Dec915019

GDHPHBLCH

Sept223

Oct7733

Nov231738

Dec29014






Sept

Oct

Nov

Dec


GDH

PHB

LCH


Vast majority of patients want to make a change..

Chart1

90

47

31

7


activity tracker













































Nov-121CNSGrantham





















































Nov-124OTPilgrim


Nov-124OTPilgrim


Nov-124OTPilgrim













































































graphs




Sept322

Oct2355

Nov

Dec

Jan

Feb

Mar

State of readiness



Sept322

Oct67105212

Nov

Dec

Jan

Feb

Mar




Sept12211

Oct5111321

Nov

Dec

Jan

Feb

Mar

graphs

Sept

Oct


Q3

Sept

Oct


Sept

Oct


Sept7

Oct37

Nov58

Dec8

CNS90

Dietician47

OT31

Physio7

GDH20

LCH64

PHB26

Ready56

Unsure24

Not ready30

GP7

Refused support7

Exercise referral11

Phoenix referral23





Sept3502

Oct33509

Nov1112055

Dec915019

GDHPHBLCH

Sept223

Oct7733

Nov231738

Dec29014






Sept

Oct

Nov

Dec


GDH

PHB

LCH


Chart1

90

44

41


activity tracker













































Nov-121CNSGrantham





















































Nov-124OTPilgrim


Nov-124OTPilgrim


Nov-124OTPilgrim













































































graphs




Sept322

Oct2355

Nov

Dec

Jan

Feb

Mar

State of readiness



Sept322

Oct67105212

Nov

Dec

Jan

Feb

Mar




Sept12211

Oct5111321

Nov

Dec

Jan

Feb

Mar

graphs

Sept

Oct


Q3

Sept

Oct


Sept

Oct


Sept7

Oct37

Nov58

Dec8

CNS90

Dietician47

OT31

Physio7

GDH20

LCH64

PHB26

Ready90

Unsure44

Not ready41

GP7

Refused support7

Exercise referral11

Phoenix referral23





Sept3502

Oct33509

Nov1112055

Dec915019

GDHPHBLCH

Sept223

Oct7733

Nov231738

Dec29014






Sept

Oct

Nov

Dec


GDH

PHB

LCH


Would these referrals have been made pre MECC initiative?

Chart1

7

11

22

23

7

12

39


activity tracker













































Nov-121CNSGrantham





















































Nov-124OTPilgrim


Nov-124OTPilgrim


Nov-124OTPilgrim













































































graphs




Sept322

Oct2355

Nov

Dec

Jan

Feb

Mar

State of readiness



Sept322

Oct67105212

Nov

Dec

Jan

Feb

Mar




Sept12211

Oct5111321

Nov

Dec

Jan

Feb

Mar

graphs

Sept

Oct


Q3

Sept

Oct


Sept

Oct


Sept7

Oct37

Nov58

Dec8

CNS90

Dietician47

OT31

Physio7

GDH20

LCH64

PHB26

Ready90

Unsure44

Not ready41

GP7

Refused support11

Exercise referral22

Phoenix referral23



Provided information39



Sept3502

Oct33509

Nov1112055

Dec915019

GDHPHBLCH

Sept223

Oct7733

Nov231738

Dec29014






Sept

Oct

Nov

Dec


GDH

PHB

LCH



Any questions?

making every contact count at united lincolnshire hospitals

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