Presentations 3 and 4 - Scottish Patient Safety Programme

Danish Patient Safety
Program for Mental
Health
Simon Feldbæk Kristensen
Danish Society for Patient Safety
Session aim
• Danish healthcare system
• Why mental health?
• Brief overview of Danish Patient Safety Program
for Mental Health
• Users and Carers Engagement
• Data and measurement
• Questions
Danish Healthcare
- Tax based financing – 103
DKR billions/year – approx 10
% of GDP
- Mental health: 7,5 billions
DKR
- 50.000 admissions
- 1.1 mil. outpatient visits
- Costs ↑
- Activity ↑
- Change in demographics
- Coordination of care
Mental Health!?
4
• People with mental health disorders have
• a life expectancy 10 – 20 years lower than the rest of
the population
• 20 times at risk of committing suicide
• mental health disorders are on the top 10 list of
diseases that causes loss of healthy life years
• High rate of mechanical restraint compared to other
countries
Life expectancy
Blue: People with mental health disorders, Total pillar: All people
Source: Danish Regions, 2011
Collaborative aim and topics
• Aim:
• Reduction in mortality
• Reduction in harm within psychiatric care
• Create a platform for continues improvement
6
7 teams
Workstreams
• Four clinical workstreams
• Safe medication
• Physical diseases/comorbidity
• Prevention of and reduction in the use of
mechanical restraint
• Suicide prevention
• Two organizational workstreams
• User and carer engagement
• Leading improvement work
Workstreams and timeline
Medicines
Physical Comorbidity
Suicide prevention
Restraint
User and carer engagement
Leading improvement work
2014
2017
Mechanical restraint (example)
Physical environment
Calm boxes
Low stimulus room
Physical activity
Patient and Carers
involvement
Debrief monitorering
Weekly patient forums
Skills, knowledge, attitiute
Open conversation
Management
Supervision
Safety care bundles
Patient at center
Language
Clinical handovers
50% reduction of mechanical
restraint within mental health
services by 2016, without
increasing other types of
restraints (psysical
interventions, medication)
Users and Carers
Low engagement
Information
High engagement
Participation
Influence
Partnership
Examples
• Users and carers part of the teams (team meetings, learning
sessions)
• Medication – med. reconciliation in partnership
• Friday café – engagement with patients and professionals
• ”Safety board” for patients
Data and measurement
• Medicines (examples)
Outcome measures Process measures
Intoxication
Medical reconciliation
Aim
No intoxication
95 %
Numerator
Days between ”case”
Number of patients
with all elements
done
Denominator
Number of
discharged patients
Data - I
Data - II
Data - III
Danish Patient Safety Program
for Mental Health
• Three year Collaborative
• 7 units
• Four clinical workstreams
• Two organizational workstreams
• Etc.
What it really is…
A cultural
journey
A journey
for and with
users,
carers and
staff
Better and
safer care
Mental
Health!
Thank you!
Sikker.psykiatri@patientsikkerhed.dk
Simon.kristensen@patientsikkerhed.dk
Northern Ireland Quality and
Safety Improvement
Collaborative – Mental Health
Our journey……
Providing leadership in
Patient Safety and Quality Improvement
across Health & Social Care
What do we do?
Promote Quality Improvement (QI)
 Engage staff
 Help design reliable processes & systems
 Facilitate standardisation/reduce variation
 Use data to uncover the real story
HSC SAFETY FORUM
QUALITY IMPROVEMENT FRAMEWORK
Unscheduled
Care
Community
Care
Maternity
Care
Paediatric
Care
Mental
Health
Primary
Care
Scheduled
Care
MENTAL HEALTH, A KEY PRIORITY … ….
Suicide in N.Ireland
UK
UK
UK suicide rate: 17/100,000 (male): 5/100,000 (female)
Male suicide in NI:
30% between 15-29 yrs
Drivers for Change
1. The Bamford Review of Mental Health and Learning Disability (NI)
2. Royal College of Psychiatrists Audit of Schizophrenia
3. Northern Ireland Mental Health Service Framework
4. NICE CG 82
5. RQIA – Evaluation of the Service Provision for Physical Health Needs
of people with a Mental Illness or Learning Disability
7. Regional Anti-Psychotic Prescribing Guidelines
8. ImROC – Recovery Colleges
9. Media
Primary Drivers
Secondary Drivers
Interventions
• Prevention.
• Crisis Resolution
Early
Intervention
• NICE 123 “
Common Mental
Problems
• NICE Guidelines
Person and
Family Centred
Care.
Hope
Opportunity
Control
Safe Evidence
Based Care
• Psychological
Therapies Strategy
•
•
•
Establish Primary Care Hubs
Implement Revised Protect Life
Psychological Medicine
•
•
Mental Health CPD Framework
Managed Care and Outcomes
Framework
Mental Health Research
Collaborative
•
• Research
• Consistency
Recovery
Orientated
Practice
Effective High
Intensity
Services
• Wellbeing
•
•
•
Standardise Care Pathways
IMROC Programme
Physical Care Model(LESTER
Principles)
•
•
•
Standardise CRHT Services
Acute Service Care Pathway
High Intensity - Low Secure
Service Model
Specialist Service Model
• Experience
• Acute High Intensity
Care Model
• Specialist Service
Model
•
“No Decision About Me
Without Me”
Purpose Of Care Pathway
Who Is Care Pathway For ?
STRUCTURE OF SAFETY FORUM REGIONAL
MENTAL HEALTH (MH) COLLABORATIVE
MH Advisory
Group
MH collaborative
Expert from
all/some trusts
Belfast Trust
MH QI group
1-2 senior staff
from each trust
The combined core
teams from all trusts
(25-30 or more staff)
Subgroup
Southern
Trust MH QI
group
Northern
Trust MH QI
group
SE Trust MH
QI group
Western
Trust MH QI
group
10 or more staff (4-6 core team and others) working on QI within each trust representing
multiprof team and staff from front line to senior staff
Pre-work: August 2013 – April
2014
•
Agreement at Strategic
Partnership Group to begin QI
Collab in Mental heatlh
•
Letter to MH Leads August
2013 asking for rep. on
Advisory Group (AG)|
•
1st AG meeting held August
2013 to identify areas of
focus
•
2nd AG meeting December
2013 – areas of focus:
crisis management and
improving physical health
needs
•
1st stage driver diagrams
developed for discussion
Mental Health Collaborative –
The Journey
Action Period 3
•
•
LS 0–
1.4.14
Action Period 2
Action Period 1
•
•
•
•
•
Trusts to form improvement
teams
Identify area to begin
improvement work
Development Regional Driver
Diagram
Development of local driver
diagrams
? Identifying areas for change –
testing
•
•
•
•
Refine Driver Diagrams
Beginning tests of change
Baselines
Measurement
Tests of change
Measurement
What are we trying to
accomplish?
DRIVERS:
PRIMARY/SECONDARY
What specific changes can we
make which will result in
improvement?
Crisis
Management
Identifying
Risk/Assessment
•
•
Risk Screening
Comp. risk
assessment
(currently under
review) LEAVE
• Risk Screen tool
• Comprehensive risk
assessment tool
FOR NOW
AIM OF WORK
The overall aim is to reduce
harm to mental health
patients by:
< number of suicides?
< episodes of self-harm?
< number of
visits/admissions to
hospital?
< number crisis presentations
Risk
Management/
Planning
Communication
Patient/Client and
family/carer
involvement
RESTRAINT
Is this separate box or
part of another driver?
• Crisis Management
Plan
• Care Pathway
• Use of hand held notes
(health passport)
• Management Plan
• Out of hours
service
• Available
information
•
•
•
•
•
• Recognition of
problems (signals)
• Education,
awareness raising
•
•
•
•
Further
discussion
required
Recovery Colleges
Telephone Help-line
Trigger List
Education
Mental Health SBAR (see eg)
Link with out of hours service
Signposting
Patient information/education
Availability of patient’s info to
family/carers
• Person Centredness
awareness training
What are we trying to
accomplish?
DRIVERS:
PRIMARY/SECONDARY
What specific changes can we
make which will result in
improvement?
PHYSICAL HEALTH NEEDS
SMOKING
(cessation and
reduction)
AIM OF WORK
The overall aim is to improve
the physical health and well
being of mental health
patients:
< no. patients who stop
smoking
< no. patient who reduce
smoking
< no. mental health patients
received health checks
IMPROVED
PHYSICAL CARE
COMMUNICATION
Patient/Client and
family/carer
involvement
• Stop smoking
• (pathway – see eg
NHS Health
Development
Agency)
•
•
•
•
• Weight loss and
improved fitness
• Monitoring of
antipsychotic
medication
• Recognition and
rescue of
deterioration
• Key worker
• Accessing services
• Use of hand held notes
(health passport)
• Local Escalation
• Information
• Between health and
social care
professionals
• Common pathways/ templates
• Key worker
• Mental Health Team (review
patient’s GP record)
• Training
• Education
• Patient information/education
• Availability of patient’s info to
family/carers
Public health - campaign
Access to services
Family involvement
Collaborative needs to agree
interventions in this section
WHAT CAN WE DO?
WHSCT:
NHSCT:
improved
physical
Health:
- Antipsychotic medicatin
- Deteriorating patients
(a) Improved physical
health
(b) Crisis management
in ED
BHSCT:
Crisis: patient
experience and effectiveness
of assessments in EDs
SET:
SHSCT:
Physical health
Crisis: stepped approach
to promoting personal safety
to reduce number crisis
presentations by existing service
users
ED Response Times August 2014
100%
% of Clinets seen iDefined Response Times
90%
80%
70%
60%
50%
% seen in < 2HRS
40%
30%
20%
10%
0%
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
DATE
Prompt and thorough assessment: Waiting time(s) in ED
• Baseline
• 56 Crisis presentations (known to team) April –
BASELINE June Average 19 per month.
Dashboard
CYCLE 1
• Cycle 1 July/August
• Staff trained in person centred practice
CYCLE 2
• Cycle 2 August/Sept
• Programme SQE to mirror learning set aims
July -18
Aug-15
Month Day
OOH
Presen Presen
tation tation
Crisis Presentations
20
19
19
19
18
18
16
15
4
August 5
14
10
No. Crisis Presentations
July
14
14
12
Monthly average
10
10
Day
Out of hrs
8
6
5
4
4
2
0
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Physical
100
90
80
70
60
50
40
30
20
10
0
Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14
Jul-14 Aug-14
Lipid Plasma Glucose/HbA1C
100
90
80
70
60
50
40
30
20
10
0
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
BP
100
90
80
70
60
50
40
30
20
10
0
Dec-13
Jan-14
Feb-14 Mar-14 Apr-14 May-14 Jun-14
Jul-14
Aug-14
Smoking Status
100
90
80
70
60
50
40
30
20
10
0
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
BMI
100
90
80
70
60
50
40
30
20
10
0
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
ECG
100
90
80
70
60
50
40
30
20
10
0
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
AND OUR JOURNEY CONTINUES … ……
• Current work continues and progresses
• Culture Surveys:
- in patient
- Home Treatment
- Community Teams
• Work with Regional Mental Health Core Care Pathway
• Regional measurement development?
• Work on restraint?
• Collaboration with colleagues