We work on a 12 bed inpatient adolescent unit. The young people admitted have a wide range of mental health difficulties, including eating disorders, and are often on psychotropic medications. They have complex associated physical health needs and as we know are a group of people who also carry a higher risk of future physical illness. In 2016 we set up a weekly physical health clinic, named (after a competition for the young people on the ward) as Wellbeing Wednesday. Every young person is seen in the clinic on the first Wednesday of their admission and at least monthly thereafter. Young people can request an appointment if required, and there is also a drop-in session over lunch time
Co-Production
From start: Yes
During process: Yes
In evaluation: Yes
Evaluation
Peer: No
Academic: No
PP Collaborative: Yes
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Catriona Mellor - Specialty Doctor, Child and Adolescent Psychiatrist - Oxford Health NHS Foundation Trust
We work on a 12 bed inpatient adolescent unit. The young people admitted have a wide range of mental health difficulties, including eating disorders, and are often on psychotropic medications. They have complex associated physical health needs and as we know are a group of people who also carry a higher risk of future physical illness. In 2016 we set up a weekly physical health clinic, named (after a competition for the young people on the ward) as Wellbeing Wednesday. Every young person is seen in the clinic on the first Wednesday of their admission and at least monthly thereafter. Young people can request an appointment if required, and there is also a drop-in session over lunch time.
This clinic tackles our patients’ physical health issues in a much more timely, efficient and structured way than previously, but also offers a much wider service. It is a safe and regular space for young people to meet with the same small wellbeing team. It aims to safeguard the physical health of our young people, empower them to manage their own health by giving information about for example medications side effect and contraception and it also aims to promote healthy living by monitoring vaccination and other screening checks, and giving information on a range of issues such as quitting smoking, improving sleep and staying active. This has made a huge difference to the young people on the ward. 1. They value a safe ‘clinical’ space where they know that any physical health issues (which are sometimes seen as embarrassing) will be monitored regularly 2. They prefer the structure of the clinic as previously investigations such as blood tests happened on an ad hoc basis with little or no warning 3. The physical health care of our patients is now more efficient and more comprehensive which means they are receiving better and safer care 4. We have cultivated an environment where physical health and wellbeing have a high profile and where conversations are had, information is given and habits formed which are likely to positively benefit our patients well into their future.
Wider Active Support
We developed this service within the mental health unit with the support and backing of Oxford Health management. We have reached out to other partnership organisations at times as and when necessary and will continue to do so (for example the school nurse network for useful and up to date resources). We have also sought additional training within Oxford Health (such as vaccination, ECG and phlebotomy competencies) for the members of the wellbeing clinic team. We have a write up of our methods, copies of audit paperwork and a presentation that we are willing to share with others who would want to drive forward with a similar project (there has been interest from other parts of the Trust in this context).
Co-Production
The young people were involved in the initial service design and we gathered qualitative survey feedback after the clinic started to monitor for change. The initial survey asked them how they found the existing physical health system and comments such as ‘give more warning for blood tests’ were made. They confirmed that they had not all been given the health information and medication information that they wanted, and the majority agreed that this was something that they would like to see change. When the young people were surveyed a few months after the change comments included “its good that you can drop in whenever (during a Wednesday)”, “it’s good that it’s on the same day”, “you get to share your worries with someone”, we like “organised schedule so no surprise blood tests”. They made suggestions for improvement such as changing one of the rooms that they were being seen in, making sure the appointments didn’t interfere with other commitments in the day, and that there should be a way of writing down what they wanted to talk about instead of having to say something that they may find embarrassing.
The team acted on this feedback. We have a weekly ‘community group’ on Fridays where staff and young people meet, and the young people can anonymously give feedback on any part of the work we do at Marlborough House. The young people minute these meetings and hold us to account to take action on any points they raise. Initially there were comments about the logistics of the clinic process, but there have not been comments about Wellbeing Wednesday for many months which is reassuring feedback in itself. We have a notice board in one of the corridors on the unit that covers a rotating range of health and wellbeing topics. The clinic staff organise the information that goes on these boards in collaboration with the young people on the ward.
Looking Back/Challenges Faced
Now the clinic is up and running it saves time but it did require a huge input initially. We were lucky that our staff nurse with paediatric nurse training took this on with such energy and it was her personal drive that meant it started running so well so quickly. Having regular meetings throughout set-up and during the first 6 months, and getting all levels of Trust management and a small team of ward staff on board before starting the clinic helped to support this. We have learned along the way and made lots of small changes in response to feedback and audit results. It would have been useful to document things more clearly initially in order to help the audit process. We now have questionnaires that are used at each clinic appointment so it is clear what has and hasn’t been discussed.
Sustainability
We have expanded the team of nursing and health care support workers leading the clinic since it began. There are two staff nurses with paediatric nurse training background and two health care support workers who are fully versed in the processes and procedures that are required to keep the clinic functioning. There is also medical staff involvement to support the weekly running of the clinic and in the administrative and audit processes. There is clear paperwork associated with the clinic which would make it relatively simple for a new member of the team to learn how it works.
Evaluation (Peer or Academic)
We have carried out qualitative survey evaluation as described above of the young people who have used the clinic. We have also audited the medical records of a group of young people who were on the ward prior to the clinic and two groups who have experienced being on the ward since the clinic was established (please see below for results).
Outcomes
The Wellbeing Clinic has received positive feedback from the young people and ward staff. Questionnaire feedback comments included ‘you can drop in whenever’, ‘you get to share your worries with someone’ and ‘no surprise blood tests’. Overall, quantitative performance improvements included a reduction in average time from admission to blood tests from 3.5 to 0.7 days and average time to ECG from 4.1 to 0.6 days, as well as increasing from 58 to 100% the proportion of young people receiving an ECG. The main area for improvement identified after the first phase of the audit was documentation of vaccines, side-effects, sexual health, dental health and eyesight. In response to this the design and the process around the routine clinic forms was modified. Following these changes, the second phase showed marked improvements in offering and documenting advice and information on vaccines, sexual health, dental health and vision. Overall, rates improved from 0% to 92-100%. The staff involved have reported improved job satisfaction and it has led to a lessening of tasks for the ward doctors who are therefore able to spend time on other tasks.
Sharing
This work has been shared with the Trust Board and at other Trust events, it has been presented at the South West Division Royal College of Psychiatrists Biannual Meeting where the work won an Innovation prize and it is currently submitted for review for publication by The British Journal of Nursing.
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