1. U Using Care Bundles Steve Kingsbury and Ann York

2. Habit Handle Demand Extend capacity. Let go of families. Process map and redesign. Flow management. Use Care Bundles. Look after staff. Average 43% 40% 30% 38% 8% 68% Data from 100 teams in 2005 Average total score 38% (42/111)

3. Remember…artificial variation  Natural variation Users are different We are different  Artificial variation How we do things Research shows that artificial variation has greatest impact on services!

4. Use Care Bundles Links to High Impact Changes number 6: ‘increase reliability of interventions by designing care based on: what is known to work and that service users and carers inform and influence’

5. Care Bundles  Manage complex problems  Reduce variation in practice  Aim to ensure everyone receives the best care  Defines what you do  Draws on evidence, expert view and user views  Easy to monitor compliance

6. Table discussion A  What problems could you develop care bundles for?

7. Developing a Care Bundle 1. Know current best practice  Decide what you are going to develop a Bundle on!  Something where a combination of approaches are needed  Find evidence e.g. NICE, Drawing on the Evidence

8. Developing a Care Bundle 2. Local best practice  Evidence from research may not be available!  Discuss and reach consensus  Ask users what works

9. Developing a Care Bundle 3: Implement and monitor  Quick checklist in file  Monitor frequently

10. e.g.Surgical site infection Bundle Appropriate antibiotic prophylaxis Control of blood glucose Use of ‘clipping' not shaving Maintain core temperature above 36.6 C

11. Developing a Care Bundle for Anorexia Nervosa in Richmond CAMHS  Eating Disorders team gathered evidence  Asked users what helped  Agreed together what needed to be done at assessment and by whom  Agreed package of interventions  Agreed monitoring  Wrote up  Have a bundle implementation plan

12. Richmond Anorexia nervosa bundle (1) Assessment Choice appointment unless BMI under 15  Multi-disciplinary assessment within 2 weeks Systemic Dietetic Psychiatric Physical EDE

13. Richmond Anorexia nervosa bundle (2) Intervention with 3 monthly reviews Physical care Family therapy Psychiatric Multifamily groups Individual Dietetic

14. School refusal bundle development in E Herts.  Process Did a team role play to explore various experiences Formed a working group Met and written a draft pathway and bundle Planning initial meeting with EWO management to understand their process After that will have multi-agency workshop to consider plan Forgotten user input!

15. Table discussion B  Go back to your suggestions  Pick one and devise a Bundle for one of them…  Who, what, where, when…