Published on March 13, 2014
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 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 PercentageofMonthlyDNAs Percentage of DNAs for Adolecence Diabetic Clinic April 2012 to December 2013 DNA% Average MI 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 35 NumberofDNAspermonth 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 COMMUNICATI ON COURAGE COMPETENCE COMMITTME NT
Any Questions? • For further information contact • Rachel Bryers • Advanced Practitioner/ Therapy Team Manager • ST Bartholomew’s Intermediate Care Service • firstname.lastname@example.org • Tel 0151 489 8724
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