Ward 1 is a recovery focused acute service providing quality and effective patient care to meet the needs of those that are have challenging behaviour. Ward 1 is a mixed acute adult mental health inpatient ward dedicated to delivering person centred care which offers intensive support, assessment and treatment in a safe supportive environment. There have been times when the lack of a PICU on site or a proper seclusion room has made working within ward one a really challenging prospect; the staff have risen to this really well and embraced the trauma informed approach Following NICE guidelines and the DoH’s, positive and proactive policy,
Highly Commended in Mental Health Safety Improvement Category - #MHAwards18
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Ward 1 is a recovery focused acute service providing quality and effective patient care to meet the needs of those that are have challenging behaviour. Ward 1 is a mixed acute adult mental health inpatient ward dedicated to delivering person centred care which offers intensive support, assessment and treatment in a safe supportive environment. There have been times when the lack of a PICU on site or a proper seclusion room has made working within ward one a really challenging prospect; the staff have risen to this really well and embraced the trauma informed approach Following NICE guidelines and the DoH’s, positive and proactive policy, healthcare providers nationwide are exploring ways to reduce the incidences of restraint. In order to do this ward one needed to look at delivering patient centred care and how trauma can impact upon this. Looking at ways in which we support patients who have had traumatic experiences is paramount to their recovery and resilience.
The ward adopted a Trauma informed approach to care to Working in partnership with Advancing Quality Alliance AquA who supports its members the North West to deliver the best health, wellbeing and quality of care for all. The program helped ward 1 to look at our care and understand methodology and quality improvement measures for continued high quality care and our safety culture. The four improvement priorities: • Delivering High Quality Care • Supporting System Transformation • Delivering Person Centred Care • Building Capability for Improvement the Acute Directorate have adopted the national model of choice for acute services and now work more in alignment with home treatment and community services. There is more work to do to progress this and this is on-going. But we have made a significant step. The cross directorate working is also a key factor having In-reach workers from Acute Home Treatment Team.
What makes your service stand out from others? Please provide an example of this.
Accreditation from AIMS Reach award Winners for leading with Compassion and Rising stars Categories for the last 2 years-2016/2017. Nominated for team of the Year 2018 More focus on person-centred care Team approach – MDT – psychological input The team need to be trauma informed – listening, recognising and understanding trauma and how it may impact the individual. Create a low stimulus environment and for staff to be confident in the management of potential violence/aggression/self-harm/risk.The ward manager and deputy are both trained in Critical Incident Stress management (CISM). The model is invaluable for staff and patients alike, it not only empowers the individuals trained but also helps those to identify stress, presentism, trauma related symptoms, risk management and psychological 1st Aid. The ward utilises support from staffs Counselling service for De-Briefs for the team following a serious incident or an accumulation of incidents. De-Briefs are also offered to patients from staff on all levels, which supports the value of individuals and preventative management. “Person-centred care is about developing a plan of care with people that fits with what that person is ready, willing and able to action. It means that the person is an equal partner in the planning of care and that his or her opinions are important and are respected.” Royal College of Nursing (2017).
How do you ensure an effective, safe, compassionate and sustainable workforce?
The ward is focused on maintaining an effective workforce and strongly follows the values of the trust, by being responsive to staffs personal development and needs. The Trust offers a comprehensive CPD programme and is strongly led by staff request for areas of further development and education. This supports a strong evidence based practice and smoothly links theory with practice. The CPD Sessions are delivered by a MDT approach and also more recently we have involved service users with staff development days. Acute services is strongly supported by psychological services and we encompass formulation meeting to gain a wider, comprehensive perspective of patient with complex needs. Alongside Reflective practice and weekly emotional skills coping groups. To understand and gain the functional aspects of a patients needs we employ a occupational therapist who offers extensive assessments and activities to allow patients functioning and goals with quality of life to be achieved.
The role is unique and it offers such reward to patient care as they have intensive support and assessments in areas which are often excluded. Working collaboratively with multi-agencies also strengthens links and roles in health and social care. Link nurses: the ward has several link nurses to support continued learning and development, shared best practice, cross directorate working. PDR’s to allow staff to the opportunity to monitor their growth within themselves, the team and the Trust. The trust offers an extensive training programme for mandatory training and has developed on-line learning to support the needs of individuals and offer a flexible approach to learning. Patient centered care plan and risk assessment. More activities and patient escorts. A better rapport between staff and patients. Patients feel empowered to be at the heart of their care and to be teaching staff about their trauma. Staff are more pro-active in psychology referrals.Ward one is a therapeutic environment for patients Recovery… staff support is heavily involved with recruitment of all staff and students. Service user and carer council have been involved with the development of the new built PICU from the design phase to the recruitment process. Ward 1 Is currently looking into the possibility of a Buddy system to allow the lived experience to be shared and understand ‘Trauma’ and the diversity of it.
How do you work with the wider system?
Work closely with Royal stoke Acute hospital for physical health pathways and training packages, West Midlands Ambulance service, Staffordshire police and Probation services. GP services, access to specialist dietary and diabetic, tissues viability, neurological and neuropsychiatry. Keele university school of Nursing and Midwifery, Staffordshire University, Safeguarding boards for stoke and Staffordshire. Re-hab services. Dual – Diagnosis nurse consultant. Arch and Brighter Futures voluntary organisations (this includes a list of useful contacts) Local authority housing providers Rethink housing Criminal Justice team Early Interventions Close relationships with commissioners Job centre and employment agencies – STEP ON project
Do you use co-production approaches?
www.thecarershub.co.uk Mental health access team – 24 hour support Carers weekly association Monthly carer’s events
Do you share your work with others?
Community resources –wide range of voluntary sector organisation Substance misuse projects and organisations.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
Plan Do Study Act – PDSA Quality improvement – Driver Diagrams RCN Nursing strategy Leading change adding value LCAV Trust 5 year strategy Restraint reduction group Aqua www.aquans.nhs.uk Safeguard reporting system Francis Report Using the tools noted in the Aqua project Since May 2017 a continual reduction in restraints from a baseline of 12.5 per month down to 3 per month – a 76% reduction in 9 months. Violent incidents of also fallen dramatically from a baseline of 16.5 per month to 5 per month, a 70% reduction in 7 months. The team have worked hard prior to the programme to reduce restraints and there is still work to do – our goal is ZERO
Has your service been evaluated (by peer or academic review)?
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
North Staffs CCG/ Stoke-on-Trent CCG
Provided by (e.g. name of NHS trust) or your organisation: *