s153 - day 2 - 1545 - embedding shared decision making in practice, learning from aqua(2)
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Health and Care Innovation Expo 2014, Pop-up University S153 - Day 2 - 1545 - Embedding shared decision making in practice, learning from AQua(2) Rachel Bryers Brook Howells Dr Harni Bharaj Emily Lloyd #Expo14NHSTRANSCRIPT
Shared Decision Making & Self-
management Support
Brook Howells
Dr Harni Bharaj
Emily Lloyd
Rachel Bryers
• Holistic care
• Collaboration
• Patient-centred care
• Partnership
• Personalised/individual care
• Choice
• Effective treatment
• Preference sensitivity
What is it all about?
Social; interactions with family, friends,
workmates
Psychological; reactions, thoughts, feelings
Biological; bodily symptoms
The House of Care Model
Empowered
patients
Engaged
professionals
Person-centred, coordinated care
What is being shared in SDM?
Clinicians
• Diagnosis
• Cause of disease
• Prognosis
• Treatment options
• Outcome probabilities
Patients
• Experience of illness
• Social circumstances
• Attitude to risk
• Values
• Preferences
AQuA Experience To Date
2011/12 2012/13 2013/14
•Awareness Raising & Engagement with members
•3 SDM Master classes
•Conference with NHS NW
•Secured NHS England implementation Programme
•Networking
•Delivered NHS England implementation Programme.
•SDM Collaborative with 33 teams – largest National Implementation
•Trained 699 clinicians across 60 training sessions
•Developed a range of patient and health professional resources
•Co-developed a new measurement tool - SHARED
•Over 500,000 A3Q leaflets distributed
•National Web Exs
•SDM/SMS Collaborative with 30 teams
•Trained 350 clinicians across 30 training sessions
•Validated the CollaboRATE tool with Dartmouth College
•MI Training – Demand outstrips supply
•New non NW organisations embedding A3Q & requesting training
•Only UK organisation implementing & embedding SDM & SMS
•Over 6,000 patient data points
Explaining Choice, Options,
Risks, and Benefits
Patients – Our Greatest Asset
• How can you work with patients/carers/relatives to co-design changes?
• How can you work with patients/volunteers to provide peer support/decision
support to patients?
• Can patients/carers/relatives give information about the experience of each
decision?
• Capturing the patient experience - case studies
The power of effective communication
Harnovdeep S Bharaj
Consultant Physician
Bolton Diabetes Center
Royal Bolton Hospital NHS FT
Let’s start by talking about Hayley.
‘SO WHAT ?’
Admissions, showing minimal differences, Further detail work needs to be
carried out on reasons for admissions, to understand where best to focus
interventions.
0
2
4
6
8
10
12
DKA Admissions Age 16-24
Admissions
Average
DKA Admissions 16 – 24 Year Olds
Number of Admissions.
April 2012 – Dec 2012 46
Number of Admissions.
April 2013 – Dec 2013 45
No Difference in
admission rate for
this group!
Total of 106 admission episodes during the period of April 2012 to December
2013 for 48 patients:
A total of 6 patients accounted for 40.5% of the total admission episodes.
The same 6 patients also accounted for 48% of the occupied bed days for this
group of patients.
0
5
10
15
20
25
30
35
40
45
50
Apr-
12
Ma
y-1
2
Ju
n-1
2
Ju
l-1
2
Aug
-12
Sep
-12
Oct-
12
No
v-1
2
De
c-1
2
Ja
n-1
3
Feb-1
3
Ma
r-13
Apr-
13
Ma
y-1
3
Ju
n-1
3
Ju
l-1
3
Aug
-13
Sep
-13
Oct-
13
No
v-1
3
De
c-1
3
Pe
rce
nta
ge
o
f M
on
thly
DN
As
Percentage of DNAs for Adolecence Diabetic Clinic April 2012 to December 2013
DNA%
AverageMI Training in August, and
applied to clinic
Consultation model altered after attending MI training & Trial of Text reminders
0
5
10
15
20
25
30
35N
um
be
r o
f D
NA
s p
er
mo
nth
Number of DNAs Diabetic Adolescence Clinic April 12 - December 13
DNA
DNA Average
RESULTS
Number of DNAs
April 2012 – December 2012 140
Number of DNAs April 2013 – December 2013 106
24% fewer DNAs in
2013 since starting
on the collaborative
Number of DNAs August 2012 –December 2012 71
Number of DNAs August 2013 –December 2013 40
43.5% fewer DNAs
during this period
once Motivational
Interviewing, Style of
Consultation altered!
Will need to be monitored monthly to see if this is a sustained trend!!
Emily Lloyd
Patient Ambassador
Presented by: Rachel Bryers - Team Leader
St. Bartholomew’s Intermediate Care Unit
Date: 4.03.14
Introduction
• St Bartholomew’s Intermediate Care Unit is a 20 bedded unit in Huyton, Knowsley.
• Collaborative relationship between the charitable home and 5 Boroughs Partnership NHS Foundation Trust
• Wanted to review the discharge planning process with a view to increasing patient engagement and clarifying expectation of all involved
Aims
• Increase the patients involvement in the care planning and discharge planning process
• Identification of the patients goals on admission
• Reduce the length of stay
• Increase patients satisfaction
• Increase confidence in decision making – both patients and staff
Case Study
• Peter was admitted to St Bartholomew’s Intermediate
care Service for a period of intensive rehabilitation.
• On admission he was provided with written and verbal
information regarding the service and the Shared
Decision Making Project.
Therapy Intervention
• Initial Assessments were completed and his therapy
goals were agreed with him.
• Following an assessment of the home environment a
meeting was held with Peter to discuss his options and
agree the discharge plan.
• This was done using tools we produced ourselves and
the AQuA 3 Questions
•
3 Questions
1) What are my options?
2) What are the pros and cons of each option ?
3) How do I get support to help me make a decision that is
right for me?
Discharge Planning
• Peter’s views, wishes and choices around discharge
were identified.
• Therapist’s recommendations were made
• Discharge plan jointly agreed.
Right to autonomy v Protection
• Peter asked to see the therapist- changed his mind
• Therapists ability to manage this- Understanding and
implementing The Mental Capacity Act 2005.
• Tools developed to increase confidence in discharge
decisions when managing complexity and risk.
Following discharge……
• Feedback from District Nurses
• Involvement of Emergency Assessment Team
• Case conference held
• Feedback from family
Conclusion
PETER
The 6 C’s
CARE
COMPASSION
COMMUNICATION
COURAGE
COMPETENCE
COMMITTMENT
Any Questions?
• For further information contact
• Rachel Bryers
• Advanced Practitioner/ Therapy Team Manager
• ST Bartholomew’s Intermediate Care Service
• Tel 0151 489 8724