 Ken Quinn –Senior Nurse NHS Fife  Glen Lomax –Senior Charge Nurse NHS Fife  Paul Smith -Nurse lecturer (Mental health) University of Dundee

 Quality improvement measure that is designed to improve the physical health screening of patients experiencing mental health problems that have been admitted to and discharged from hospital.  The project also aims to improve the communication of our patients physical health needs to maximise their likelihood of seeking/accessing necessary treatment.

 “There is robust historical evidence to demonstrate that individuals with serious mental illness suffer excessive physical ill-health. Evens so far as to estimate that people with severe mental illness have a life expectancy diminished by some years.” Collins et al  The Scottish Executive has stated their intention to ensure where possible & appropriate that those patients, who suffer from severe and enduring mental illness, will have a physical assessment every 15 months.

 Mental Health Strategy for Scotland  Towards a Mentally Flourishing Scotland: Policy & Action Plan  Mental Health in Scotland – Improving the Physical Health & Wellbeing of Those Experiencing Mental Illness, 2008

 To improve the physical health & care of MH patients.  To raise awareness of the impact of mental health on physical well being amongst the multi-disciplinary team.  To raise awareness of government legislation/drivers and current research regarding the physical health of patients experiencing mental health problems.

 To provide effective screening of patients physical health needs with appropriate action and signposting.  To identify unhealthy/healthy physical parameter demographics.  To improve the communication of patient’s physical health needs to the community teams/primary care service.

 Based on a similar tool developed by the University of Hull.  First championed by Paul Smith, Clinical Nurse Educator, NHS Fife and was developed between various departments at Whyteman’s Brae hospital and the Heart Disease Managed Clinical Network (MCN) at Cameron Hospital.  This group then identified the necessary health parameters and developed the tool using the latest evidence & research…creating the finalised version of the Passport to Health.

 Development of Passport to Health workbook & slideshow presentation for teaching staff, both of which provide the core information with regard to the 20 Parameters of Health.  Implementation of tool on Ravenscraig.  Now being used in the Fife Acute Admission wards, Community Teams & Addiction services.

 Further Joint working with the Heart Disease MCN & the Organisational Learning & Development Department to expand the project, secure funding & create a project group.  Funding has been secured for the Development of an e- learning module.  Kirkcaldy/Levenmouth & West Fife GP’s…given a presentation on the Passport to Health…GP’s are supportive of the project but want the recordings from Parameters 1- 5 for their records.

 Developing the patients Passport to Health record  Development & modernisation of the Passport to Health workbook for professional printing.  Identification of Passport to Health Champions & the development of their training programme.  More funding from NES has been secured to increase project resources and project support from the University of Dundee.

 Pulse  Blood Pressure  BMI  Cholesterol  Glucose  Diet  Urine/Bowels  Sleep  Exercise  Smoking  Alcohol  Sexual Function  Sexual Health  Feet  Teeth  Eyes  Blood Bourne Viruses  Testicular Check  Cervical Smear  Breast Check

 The passport should be completed at the earliest opportunity.  In the first 5 Parameters of Health whereby an observation/clinical procedure has to be completed, the recording should be documented on the back of the Passport – see Patient Sample.  For the rest of the parameters…if you tick a red box…write on the back what the recommended action is…if you tick a green box…you don’t make an entry on the back.

 If any of the parameters 1 to 3 are categorised as red, they should be reported to medical staff as soon as possible..  Once the passport has been completed, it should remain in the nursing notes until the discharge process.  The patient will be given a mini version of the tool to keep as their record of the advice for improving their health.  When the patient is being discharged a copy should be sent, along with a covering letter to the GP.  A copy should also be sent to the Community Teams/Day Hospital so they can assist the patient to act upon the health advice given.

After consultation with the Fife GP’s & Consultant Psychiatrists….  This is the only Parameter whereby a doctor/phlebotomist is required to assist in completing the tool, by means of taking bloods.  Cholesterol & Glucose bloods are only to be taken from patients whom can be categorised as having a severe and enduring mental illness or who are currently on anti-psychotic medications.  It would be inappropriate to take Cholesterol & Glucose levels for every patient when there is not a clinical need to do so.

 If you are interested with regard to using the Passport to Health in your area, you can contact…  Glen Lomax  Ken Quinn  Paul Smith We would be glad to help!