Physical Health Assessment Clinic for People with a Serious Mental Illness (SMI) in an Acute Psychiatric Setting

NHS England Released CCG Guidance in Feb 2018 Improving physical healthcare for people living with severe mental illness (SMI) People with SMI face one of the greatest health inequality gaps in England. The life expectancy for people with SMI is 15–20 years lower than the general population. This disparity in health outcome is partly due to physical health needs being overlooked. 20/11/2018 18:03:37

Continuation .… Individuals living with SMI are not consistently offered appropriate or timely physical health assessments despite their higher risk of poor physical health Not supported to use available health information and advice or to take up tests and interventions that reduce the risk of preventable health conditions 20/11/2018 18:03:37

National Clinical Director for Cardiac Care “We can no longer see patients with serious mental illness only through the prism of their mental health; we must ensure all their health needs are monitored and catered for equally” Huon Gray, National Clinical Director for Cardiac Care 20/11/2018 18:03:37

What is a NHS Health Check? The NHS Health Check is a health check-up for adults in England aged 40-74 to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. 20/11/2018 18:03:37

For People living with a SMI The recommended physical health assessment aligns to the NHS Health Check. Offered annually to all age groups (rather than every 4 years to people aged 40-74). In addition assessment should include relevant national screening and immunisation programmes, medicines reconciliation, and additional general physical health enquiry into sexual health, oral health and substance misuse. 20/11/2018 18:03:37

Physical Health Policy We have a trust-wide physical health policy that sets out the roles and responsibilities of clinical staff ( medical, nursing, physiotherapy and Occupational Therapy) when a person is admitted to our service 20/11/2018 18:03:37

Physical examination on admission Including: Physical examination on admission Routine bloods including Hba1c/lipids/cholesterol Electrocardiogram (ECG) EoC screening tool Lester tool Screening and care plan National Early Warning Scores (NEWS) Situation Background Assessment Recommendation Decision (SBARD communication tool for facilitating handover to the medical team in a medical emergency) Malnutrition Universal Screening (MUST) Venous Thromboembolism (VTE) Assessment Falls assessment Risky Behaviours including Substance, Alcohol dependence and Sexual health Acute Kidney Injury (AKI) Sepsis 20/11/2018 18:03:37

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Physical Health Nurse We recruited a RMN to a band 6 Physical Health Nurse to support the development in addressing physical health and mental health conditions. The role would require them to work across Acute inpatient services and this would include both Working Age Adults and Older People wards. 20/11/2018 18:03:37

Physical Health Nurse Role ECT Supporting Lester Tool Implementation Healthy Lifestyles Risky Behaviours CQUIN’s (smoking, substance misuse, alcohol) Ward based Physical Health Assessments for people with SMI’s who may not have previously accessed services or have been difficult to engage in the community. 20/11/2018 18:03:37

Closing the GAP 20/11/2018 18:03:37

Physical Health Assessments Clinics On An Acute Psychiatric Ward To identify those people who have been admitted to the Working Age Adult Ward that have a SMI and may not have engaged in regular Physical health Screening and require a comprehensive physical health assessment. 20/11/2018 18:03:37

To build up a rapport, engagement, explain the purpose for the assessment and to offer an appointment to conduct the physical health Assessment. Include Cardio-Metabolic screening and assessment of conditions such as diabetes, COPD, Wound management, non-routine bloods and any other pre-existing physical health conditions. Provide support and advice on smoking cessation, sexual health, healthy lifestyles, and sign posting to appropriate services. 20/11/2018 18:03:37

Requirements Identify and acquire the Equipment needed. Training need, Diabetes, COPD, Asthma, Wound Care Attending GP practice Health Assessment Clinics To Identify the physical health nurse role with the ward and medical staff and what it would provide. Support from the wards to identify people that need a more in-depth Physical Health Assessment 20/11/2018 18:03:37

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Challenges identified Not duplicating assessment data, using the Physical Health Assessment on Rio. Needed to Identify who is responsible for escalating actions, treatments and referrals. Capacity and concordance of the patient Time to support staff in implementation of the Lester tool Consider Resources available due to part time working 20/11/2018 18:03:37

Expected Outcomes of the Physical health Assessment Liaising with the Ward/Medical staff findings from the Physical Health Assessment and share any further information gained. Discussions to identify if any further interventions, investigations or treatments are required. Supporting Ward staff in managing physical conditions and access to further physical health screening or investigations. Improved staff knowledge and confidence in managing physical health 20/11/2018 18:03:37

Support the patient to attend physical health investigations or screenings. Education on prevention or exacerbation of physical health conditions Advice on managing physical health. Understanding the impact of Mental health on Physical Health conditions (Vice Versa) Support and signposting to access services in the community 20/11/2018 18:03:37

What has worked? 2gether countywide policy for Physical Health as it’s useful guide for staff to use when a patient has been admitted into our services. Ability to educating the ward staff using an ad-hoc approach to support them in implementing the Lester tool. Putting routine bloods and Lester tool requirement's into the Doctors rotation induction. Therapeutic time to build a rapport with patients Attending the Physical Health Forum on a monthly basis 20/11/2018 18:03:37

Building relations with local health provider services Spending time in GP surgery to observe how they implement the Physical Health Checks Gathering resources and local services for supporting/signposting patients and ward staff. Building relations with local health provider services Physical health and lifestyle assessment tool (Lester tool) on RIO Audit of physical health assessment, have seen improvements with the ward completing the tools, identifying interventions and referral or commencement of treatments. 20/11/2018 18:03:37

Improvements Required Further allocated Time to develop the post to establish clinic days on the acute ward. Ability to release Ward staff to attend physical health training, such as wound care/Diabetes. Developing staff confidence with managing physical health conditions Communication- To embed with clinical staff the need for Physical Health Clinics, the aims and expected outcomes 20/11/2018 18:03:37

Investment in further resources- limited hours due to only being contracted 22hrs per week. Reduced Medical cover to the unit overall and needing to recruit Clinical Fellows and Physicians. Ability to support Ward Doctors in basic duties to allow them to conduct more in-depth assessments. Who is responsible for following up the interventions/treatments set in place once discharged due to early planned discharges 20/11/2018 18:03:37

Development of Physical Health Nurse Role Wider understanding and Implementation of NICE guidance for each action in the Lester Took as part of evidence based practice. Improve communication by liaising with new staff when they first start, informing them of the Lester tool and what the role entails. Staff re-visiting and/or accessing Making Every Contact Count (MECC) training. Implementing MECC toolkit to focus on ‘change behaviour’. Time for staff to attend training to gain more knowledge and confidence regarding physical health and to keep their skills and competencies up to date. To develop a team of nurses with an interest in physical health to provide support, education and clinical expertise to the inpatient service 20/11/2018 18:03:37

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