No More Loafing Around

Carl Isherwood

Acting Nurse Unit Manager Elouera Unit Forensic Hospital Elizabeth Twomey

Nurse Unit Manager Long Bay Hospital Rosa Garcia

Social Worker Dee Why Unit Forensic Hospital

Aim Statement • Aim Promoting healthy weight through education and review of the Elouera Meal Provision Program in alignment with the Recovery Model Principles . • This will be achieved through identifying a problem

with weight gain that the patients’ will be willing to solve.

• The project team will develop measureable tools that focus on pre and post implementation data.

• To ensure the project will provide a cost benefit to the Elouera Unit.

• An optimal outcome for patients’ within a suitable timeframe is a priority of this project

Team members & role Project Team Members • Carl Isherwood (Project Leader) • Elizabeth Twomey (Data Analysis) • Rosa Garcia (Literature Review) Patient / consumer involvement: • Elouera patients participated

– In meetings with the project teams – Focus groups – In providing feedback – In the decision making process regarding change

Recovery • It is important to remember that recovery is not

synonymous with cure. • Recovery refers to

both internal conditions experienced by persons who describe themselves as being in recovery - hope, healing, empowerment and connection - and external conditions that facilitate recovery - implementation of human rights, a positive culture of healing, and recovery-oriented services. (Jacobson and Greenley, 2001 p.482)

www.health.gov.au

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Recovery Model Principles

Principles of Recovery Oriented Mental Health Practice

• 1. Uniqueness of the individual • 2. Real choices • 3. Attitudes and rights • 4. Dignity and respect • 5. Partnership and communication • 6. Evaluating recovery www.health.gov.au

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Recovery Model Principles • 2. Real choices • Recovery oriented mental health practice: • supports and empowers individuals to make their

own choices about how they want to lead their lives and acknowledges choices need to be meaningful and creatively explored

• supports individuals to build on their strengths and take as much responsibility for their lives as they can at any given time

• ensures that there is a balance between duty of care and support for individuals to take positive risks and make the most of new opportunities

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Evidence for there being a problem worth solving • Anecdotal evidence suggests that patients in the Forensic Hospital

are prone to substantial weight increases throughout their stay, leading to increased rates of diabetes, heart disease and other adverse physical and psychological health outcomes. Of particular concern was the patient group in the lower security units, especially the Elouera unit, where rapid weight increases amongst individuals had been observed by practitioners.

• There are multiple factors in this unique environment that could contribute to weight gain, including (but not necessarily limited to):

• Quality of standard diet • Access to unhealthy foods in addition to standard diet • Medication with weight gain side effects • A sedentary lifestyle due to security restrictions • Boredom

With which National Standard or strategic imperative is the project aligned?

• This project is commissioned through the Justice Health Clinical Excellence Commission in the in response to practitioner concerns that substantial weight gain was occurring in their patients during their time at the hospital. The patients on Elouera unit, comprising both the longest serving patients and those with most discretion over diet and exercise, were identified as a priority research group (20 patients).

• In 2014 the Better Health Committee in the Forensic Hospital commissioned the “Weight Gain Report” a study which corroborated anecdotal evidence and assessed the seriousness of any potential weight gain. However it did not attempt to “identify the causes, or mix of causes, which are contributing factors to weight gain in the Forensic Hospital.”

• In 2015 The Elouera Unit Meal Provision Program is being reviewed. Brad Roser C.N.C. and Mililani Ray O.T. are facilitating the review in consultation with the Elouera M.D.T. and Elouera Patients. One of the many area’s which are being reviewed is “Patient Physical Health Management” which looks at addressing weight gain and its associated co- morbidities in consultation with patients through support and education.( e.g. helping patients address portion sizes)

45

65

0

10

20

30

40

50

60

70

2014 2015

The Forensic Hospital – Elouera Ward Percentage of patients identified with Metabolic Syndrome

60

70

0

10

20

30

40

50

60

70

80

90

100

2014 2015

The Forensic Hospital – Elouera Ward Percentage of patients with a blood cholesterol greater than 5.5 mmols /L and / or

prescribed lipid lowering medications

40

45

0

10

20

30

40

50

60

70

80

90

100

2014 2015

The Forensic Hospital – Elouera Ward Percentage of patients with Non-Insulin Dependent Diabetes

94.63

29.05

92.18

29.55

0

10

20

30

40

50

60

70

80

90

100

Average Weight Average BMI

The Forensic Hospital - Elouera Ward: Average weights and BMI's of patients in 2014 and 2015

2014 2015

Patient Medications

0200400600800

10001200

Pt1 Pt 2 Pt3 Pt 4 Pt5

Milligram

Elouera Patients

Elouera 5 Recent Patient's Prescribed Metformin

2014

2015

0

10

20

30

40

50

Pt1 Pt 2 Pt3 Pt 4 Pt5

Milligrams

Elouera Patients

Elouera 5 Recent Patient's Prescribed Simvastatin

2014

2015

Client comes into prison

Project Team to collect patient

data

Project Team to engage with Elouera patients and MDT to discuss implementation of change

Project Team to meet and

analyse data

Project in alignment with

Recovery Model Principles

Implement Change

Develop feedback form/ bread register

Discuss patient feedback with Elouera MDT

Engage with patients in focus

groups

Explore positives

Spread benefits

Approval of change

Educate staff

High Level Flow

Current status

Detailed Level Flow

Project Team to engage with Key

stakeholders

Evaluate data

Change meets SMART

requirements

Discuss with patients and

MDT

Project outcome to be ongoing

Elouera Patient Feedback Form

16

17

32%

21% 16%

10%

16%

5%

Elouera Patients (20)Feedback Weight Gain Contributing Factors

Medications

Bread

Milk

Milo

Kiosk

Shopping Order

PRESENTATION NAME – MONTH YYYY PRESENTER NAME

Results • Q.1. YES: 13 NO: 7 • Q.2. YES: 16 NO: 4 • Q.4. YES: 14 NO: 6

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Medirest Patient Ordering Form

Next steps

• Measuring the impact of the project will require the development of the following tools:

• Bread register document • Patient feedback form pre and post

implementation

Intervention - plan, protocol etc • Metabolic Monitoring • Patient Survey • Bread Register • Survey of patient awareness of health / diet pre / post • Review of meal provision program

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Patient Feedback Pre/Post Implementation

Results

Pre Implementation White: 8 Brown: 5 Multigrain: 7 TWO: 9 FOUR: 9 SIX: 2 Eight: 0 YES: 12 NO: 8 Post implementation White: 5 Brown: 7 Multigrain: 8 TWO: 10 FOUR: 9 SIX: 1 Eight: 0 YES: 18 NO: 2

Strategies for Sustaining Improvement (holding the gains) • Elouera Staff will continue to provide

education to patients regarding healthy bread intake, and to promote the completing of a weekly food diary.

PRESENTATION NAME – MONTH YYYY PRESENTER NAME 27

Strategies for Spreading

• The Elouera Unit Multidisciplinary Team (MDT) has engaged well with the Project Team. The Elouera MDT has commenced a change regarding the 3rd major weight gain issue identified (Milk).

• This project will be discussed at the Forensic Hospital Governance Meeting, and at the monthly Forensic Hospital Nurse Unit Managers Meetings

Cost Effectiveness • Medications • Bread • Milk • Milo • Kiosk • Shopping Order

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Learnings from CLP/CPI • Teamwork • Transformational Leadership • Developing Improvement Projects as per

SMART: Specific, Measurable, Achievable, Realistic, and Time Based

Thank You • Elouera Patients • Elouera Multidisciplinary Team • Dale Owens (MHOAT and Quality Care)

Coordinator • Valerie Bailey (Project Sponsor) • Grant Kinghorn (Nurse Manager-Practice

Development Unit)

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Questions?

• For further information please contact: Carl Isherwood Carl.Isherwood@justicehealth.nsw.gov.au Thank You

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