Emotional Well Being on an Acute Stroke Unit Implementation of a Mood Screening Pathway Walsall Healthcare NHS Trust Dr Amanda Campbell - Clinical Psychologist Sonia Jenkinson - Lead nurse

Acute Stroke Unit 28 bedded combined acute & rehabilitation ward 14.5 days average LOS – 45% discharged by day stroke admissions per year Integrated stroke service Hyperacute, acute, ESD, rehabilitation, long term care 1.00 WTE psychologist across whole pathway Life time psychology service

Why is emotional wellbeing important Physical Mobility Sight Dexterity Mental Confidence Happiness Identity Social Valued roles Relationships Financial stability Stroke impacts on mood and social circumstance not just on physical systems Emotional wellbeing can impact upon physical recovery Effect not always apparent in acute stage Early intervention can improve longer term outcomes

How things were 12 months ago HADS tool (hospital anxiety and depression score) and SADQ- 10 (stroke aphasic depression tool) Assessed at 14 days Over 60% patients discharged before 14 days Poor uptake by nursing staff Carried out by OT’s – reactive and not proactive Not an ideal tool for acute patients, or patients with aphasia or cognitive impairment Poor data collection

How things were 12 months ago Referrals to psychology service: Hit and miss Limited service in acute care No documented process for nursing staff Urgent referrals were ad hoc Non urgent referrals not seen until discharged into the community

Review of pathway Identified need to review current pathway for emotional wellbeing in acute care Appointment of an additional psychologist Allocated weekly sessions by on acute ward Able to see patients on ward Liaise with nurses, doctors, physiotherapists, OT’s & SLT Provide training and support for staff Questionnaire undertaken by staff about perception of emotional wellbeing

Staff Questionnaire All recognised that emotional wellbeing was important Only 40% patients were asked about their emotional wellbeing Main barriers to asking patients about emotional wellbeing were Communication Experience, knowledge and confidence Workload

Inpatient Emotional Wellbeing Pathway

Depression Intensity Scale (DISC) Score of 5 or 6 request Distress Thermometer assessment by OT

Stroke Aphasic Depression Questionnaire (SADQ) Score Distress thermometer assessment Score refer to Clinical Psychologist

Distress Thermometer

Implementation 6 mths funding from the BCCN for 0.6 WTE psychology assistant Consulted with staff to adapt the tool Training sessions with staff Assistant psychologist ward based to help with Implementation Prompt staff Minor interventions Collect data and monitor progress Weekly support for the psychology assistant

How it works in practice Nurses carry out DISCS & SADQ-10 on day 5 Patient reassessed weekly If patient triggers then OT completed distress thermometer or seen by psychology assistant Referral to psychologist if needed for assessment, intervention and follow up Psychology assistant attends weekly MDT patient reviews Data collected on stroke register and psychology data base, will then be able to input data on SNAP at 6 mths

Evaluation Repeat staff questionnaire in October (at 6 mths) Numbers screened Reasons for not screening Number of referrals to psychologist Appropriateness of referrals Patient questionnaire in January 2013

Future Funding extended for a further 6 mths Results of evaluation Adapt tools and pathway if necessary Develop nurse link worker Develop the cognitive screening pathway Group sessions on ward for patients and carers

Any Questions Thank you for listening

Contacts Dr. Dominic Crowley: Dr Amanda Campbell: Sonia Jenkinson: