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S153 - Day 2 - 1545 - Embedding shared decision making in practice, learning from AQua(2)
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S153 - Day 2 - 1545 - Embedding shared decision making in practice, learning from AQua(2)

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Health and Care Innovation Expo 2014, Pop-up University …

Health and Care Innovation Expo 2014, Pop-up University

S153 - Day 2 - 1545 - Embedding shared decision making in practice, learning from AQua(2)

Rachel Bryers
Brook Howells
Dr Harni Bharaj
Emily Lloyd

#Expo14NHS

Published in: Health & Medicine

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  • 1. Shared Decision Making & Self- management Support Brook Howells Dr Harni Bharaj Emily Lloyd Rachel Bryers
  • 2. • Holistic care • Collaboration • Patient-centred care • Partnership • Personalised/individual care • Choice • Effective treatment • Preference sensitivity What is it all about? Social; interactions with family, friends, workmates Psychological; reactions, thoughts, feelings Biological; bodily symptoms
  • 3. The House of Care Model Empowered patients Engaged professionals
  • 4. Person-centred, coordinated care What is being shared in SDM? Clinicians • Diagnosis • Cause of disease • Prognosis • Treatment options • Outcome probabilities Patients • Experience of illness • Social circumstances • Attitude to risk • Values • Preferences
  • 5. AQuA Experience To Date 2011/12 2012/13 2013/14 •Awareness Raising & Engagement with members •3 SDM Master classes •Conference with NHS NW •Secured NHS England implementation Programme •Networking •Delivered NHS England implementation Programme. •SDM Collaborative with 33 teams – largest National Implementation •Trained 699 clinicians across 60 training sessions •Developed a range of patient and health professional resources •Co-developed a new measurement tool - SHARED •Over 500,000 A3Q leaflets distributed •National Web Exs •SDM/SMS Collaborative with 30 teams •Trained 350 clinicians across 30 training sessions •Validated the CollaboRATE tool with Dartmouth College •MI Training – Demand outstrips supply •New non NW organisations embedding A3Q & requesting training •Only UK organisation implementing & embedding SDM & SMS •Over 6,000 patient data points
  • 6. Explaining Choice, Options, Risks, and Benefits
  • 7. Patients – Our Greatest Asset • How can you work with patients/carers/relatives to co-design changes? • How can you work with patients/volunteers to provide peer support/decision support to patients? • Can patients/carers/relatives give information about the experience of each decision? • Capturing the patient experience - case studies
  • 8. The power of effective communication Harnovdeep S Bharaj Consultant Physician Bolton Diabetes Center Royal Bolton Hospital NHS FT
  • 9. Let’s start by talking about Hayley.
  • 10. ‘SO WHAT ?’
  • 11. Admissions, showing minimal differences, Further detail work needs to be carried out on reasons for admissions, to understand where best to focus interventions. 0 2 4 6 8 10 12 DKA Admissions Age 16-24 Admissions Average
  • 12. DKA Admissions 16 – 24 Year Olds Number of Admissions. April 2012 – Dec 2012 46 Number of Admissions. April 2013 – Dec 2013 45 No Difference in admission rate for this group! Total of 106 admission episodes during the period of April 2012 to December 2013 for 48 patients: A total of 6 patients accounted for 40.5% of the total admission episodes. The same 6 patients also accounted for 48% of the occupied bed days for this group of patients.
  • 13. 0 5 10 15 20 25 30 35 40 45 50 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 PercentageofMonthlyDNAs Percentage of DNAs for Adolecence Diabetic Clinic April 2012 to December 2013 DNA% Average MI Training in August, and applied to clinic Consultation model altered after attending MI training & Trial of Text reminders
  • 14. 0 5 10 15 20 25 30 35 NumberofDNAspermonth Number of DNAs Diabetic Adolescence Clinic April 12 - December 13 DNA DNA Average
  • 15. RESULTS Number of DNAs April 2012 – December 2012 140 Number of DNAs April 2013 – December 2013 106 24% fewer DNAs in 2013 since starting on the collaborative Number of DNAs August 2012 –December 2012 71 Number of DNAs August 2013 –December 2013 40 43.5% fewer DNAs during this period once Motivational Interviewing, Style of Consultation altered! Will need to be monitored monthly to see if this is a sustained trend!!
  • 16. Emily Lloyd Patient Ambassador
  • 17. Presented by: Rachel Bryers - Team Leader St. Bartholomew’s Intermediate Care Unit Date: 4.03.14
  • 18. Introduction • St Bartholomew’s Intermediate Care Unit is a 20 bedded unit in Huyton, Knowsley. • Collaborative relationship between the charitable home and 5 Boroughs Partnership NHS Foundation Trust • Wanted to review the discharge planning process with a view to increasing patient engagement and clarifying expectation of all involved
  • 19. Aims • Increase the patients involvement in the care planning and discharge planning process • Identification of the patients goals on admission • Reduce the length of stay • Increase patients satisfaction • Increase confidence in decision making – both patients and staff
  • 20. Case Study • Peter was admitted to St Bartholomew’s Intermediate care Service for a period of intensive rehabilitation. • On admission he was provided with written and verbal information regarding the service and the Shared Decision Making Project.
  • 21. Therapy Intervention • Initial Assessments were completed and his therapy goals were agreed with him. • Following an assessment of the home environment a meeting was held with Peter to discuss his options and agree the discharge plan. • This was done using tools we produced ourselves and the AQuA 3 Questions
  • 22. 3 Questions 1) What are my options? 2) What are the pros and cons of each option ? 3) How do I get support to help me make a decision that is right for me?
  • 23. Discharge Planning • Peter’s views, wishes and choices around discharge were identified. • Therapist’s recommendations were made • Discharge plan jointly agreed.
  • 24. Right to autonomy v Protection • Peter asked to see the therapist- changed his mind • Therapists ability to manage this- Understanding and implementing The Mental Capacity Act 2005. • Tools developed to increase confidence in discharge decisions when managing complexity and risk.
  • 25. Following discharge…… • Feedback from District Nurses • Involvement of Emergency Assessment Team • Case conference held • Feedback from family
  • 26. Conclusion PETER The 6 C’s CARE COMPASSION COMMUNICATI ON COURAGE COMPETENCE COMMITTME NT
  • 27. Any Questions? • For further information contact • Rachel Bryers • Advanced Practitioner/ Therapy Team Manager • ST Bartholomew’s Intermediate Care Service • rachel.bryers@5bp.nhs.uk • Tel 0151 489 8724

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