1. Safe and systematic approach to venepuncture for adults with learning disabilities in Barnsley Bev Bunniss & Joanne Brown

2. Why are we here?

3. The Issue Some people with learning disabilities in Barnsley were not having the blood tests they needed due to their behaviour and their lack of mental capacity This could also apply to people not being prescribed medication which would be most beneficial for their condition as blood monitoring cannot be achieved Having bloods taken but restrained inappropriately There was no safe way to have a blood test

4. Eureka!!

5. Developing a Procedure Equity Person Centred Approach System Promote access to mainstream health services Identify clear roles & responsibilities Transparency Laws of the Land Assessment & Documentation

6. Training Opportunities Word of Mouth

7. How many? Referred 2009 – 8 2010 – 22 2011 - 19 Actual 2009 – 7 2010 – 17 2011 - 12

8. Case Study 1 38 year old man, non verbal, uses some Makaton Scared of needles Previous bad experience in GP surgery (held down on floor by 5 people) Home assessment of capacity to consent Picture book on day Consented to being held on the day Bloods successfully obtained

9. Case Study 2 50 year old lady with Down’s Syndrome Health deteriorating, concerns from care team Failed attempts by District Nurses Problems with Best Interest form 4 referrals in 7 months Needed for medication titration With restraint bloods obtained successfully by District Nurse & GP Level of restraint reduced each time Current time – does not require physically holding Last referral not actioned.

10. Case Study 3 39 year old man, severe learning disabilities. Highly complex needs Unexplained weight loss-requiring blood test 1 st test to aid diagnosis Required CT scan under anaesthetic Best interest meeting Needed blood test for anaesthetist to assess Obtained and CT scan performed Restraint used by team in hospital to assist with cannulation

11. Outcomes Also used techniques to assist in PEG removal Siting of cannulas Flu immunisation

12. Early detection & prevention of ill health and access to appropriate screening/treatment regimes Anaemia Medication changes Thyroxine Anti convulsant levels Lithium Hormonal levels Annual Health Check Elementar y

13. Treating people with dignity and respect Respect is taking into consideration the views and desires of others, and including it into your decisions. When you respect another, you factor and weigh their thoughts and desires into your planning and balance it into your decision making.

14. Improving education, skills and knowledge of primary care staff The most important practical lesson than can be given to nurses is to teach them what to observe. Florence Nightingale

15. Minimising abuse of individuals, reducing distress and physical harm when being inappropriately physically restrained “I like restraint, if it doesn't go too far.” Mae West

16. Promote positive relationships between the individual and primary care staff

17. Future Developments Review procedure Continue to inform primary and secondary care staff Medical changes to review medications and look at different treatments which require less blood monitoring