Healthcare Improvement Scotland s Improvement Hub. SPSP Mental Health. End of phase report November 2016

Transcription

1 Healthcare Improvement Scotland s Improvement Hub SPSP Mental Health End of phase report November 2016

2 Healthcare Improvement Scotland 2016 First published November 2016 This document is licensed under the Creative Commons Attribution-Noncommercial- NoDerivatives 4.0 International Licence. This allows for the copy and redistribution of this document as long as Healthcare Improvement Scotland is fully acknowledged and given credit. The material must not be remixed, transformed or built upon in any way. To view a copy of this licence, visit

3 Contents Introduction 4 Safety Principles and overarching themes 7 Patient Safety Climate Tool 10 Service user and carer involvement 12 Taking a human rights based approach 13 What does the data tell us? 14 Next steps 16 Conclusion 18 3

4 Introduction The Scottish Patient Safety Programme (SPSP) is now part of Healthcare Improvement Scotland s Improvement Hub supporting improvement across health and social care. This is a unique national programme that aims to improve the safety of healthcare and reduce the level of harm experienced by people using healthcare services. SPSP aims to support National Health and Wellbeing Outcome 7: People using health and social care services are safe from harm. SPSP Mental Health aim Patients are and feel safe, Staff are and feel safe. Cultivating learning amongst those delivering and in receipt of care, and using that knowledge to improve safety are core values of the Scottish Patient Safety Programme for Mental Health (SPSP-MH). Through collaboration and innovation from staff, service users and carers and the use of quality improvement and improvement science over the last 4 years, we are now starting to see significant reductions in self harm, seclusion, violence and aggression, and restraint across a number of areas in Scotland. 4

5 The phases of the Scottish Patient Safety Programme for Mental Health Year zero Pre-work January 2012 August 2012 Phase one Testing (inpatients) August 2012 September 2013 Phase two Consolidation and Spread September 2013 September 2016 Identifying new areas of testing November 2015 September 2016 Phase three Testing and spread: Child and Adolescent Mental Health Services (CAMHS), Community, Older Adult Services, Perinatal Mental Health September 2016 onwards During the first year of Phase two ( ), there was gradual and sustainable spread of the programme, following on from the work undertaken during Phase one ( ). Phase two has seen, through workstream development groups, the development, defining and evidencing of the Safety Principles in Mental Health. Work on these Safety Principles will be ongoing throughout the programme. Medicines Risk Assessment and Safety Planning Leadership and Culture Violence, Restraint and Seclusion Reduction Communication at Transitions 5

6 What progress have we made? An increasing number of wards and units are showing improvements in rates of violence and restraint, seclusion and percentage of individuals self harming. There are examples of reductions in restraint of up to 57%, reduction in the percentage of patients who self harm of up to 70% and reduction in the rates of violence of up to 78%. The Safety Principles in Mental Health have been identified as interactions, tools and processes that can contribute to a reduction of harm measurable through the SPSP-MH Outcome Measures. This is supported by the ward profiling activity that is currently being tested across NHS boards. NHS boards are submitting their leadership reports every 2 months, which are then aggregated and circulated to all SPSP-MH programme managers and leads for networking and the sharing of best practice. SPSP-MH, working in partnership with the Scottish Human Rights Commission, is ensuring human rights based delivery of the programme. Increasing service user, carer and third sector involvement in SPSP-MH, including attendance at learning sessions. At the regional learning sessions in September 2015, over 14% of delegates were service users, carers or third sector. Examples of partnership working include Support in Mind Scotland, Lanarkshire Links, User Carer Involvement (UCI), Carers Trust Scotland, Highland Users Group, Scottish Recovery Network, See Me, Voices of experience and Bipolar Scotland. Phase three (prototyping year) of the programme began in September 2016 and included for the first time CAMHS, Community, Older Adult Services and Perinatal Mental Health alongside existing inpatient safety work. There have been over 600 facilitated Patient Safety Climate Tool surveys completed and over 3,000 staff climate surveys have been undertaken. There are a number of references in NHS boards to suggest the programme has influenced attitude and cultural change, including the approach taken to the prescribing and administration practice of as required psychotropic medication, how restraint is viewed and how challenging behaviour is managed. Collaboration with other healthcare organisations to support learning and development within the UK, as well as internationally, which involved leading the development of the #MHimprove, an international improvers network. 6

7 Safety Principles and overarching themes Based on evidence from NHS board activity, workstream development groups and extensive (and ongoing) literature searches, the programme developed the Safety Principles in Mental Health (supported by overarching themes). The Safety Principles are a number of tools, techniques and processes that are being reviewed and tested with the view that all or a combination of these will contribute to a measurable reduction of harm. Safety Principles Communication at Transitions Admissions and Discharge Follow up Procedures Leadership and Culture Patient Safety Climate Tool Risk Assessment and Safety Planning Risk Assessment Training Daily Goal Setting Staff Climate Tool Risk Assessment Timings and Review Safety Briefing and Huddles Physical Health Absconding, Missing Persons and Pass Plans Leadership Walkrounds/ Safety Conversations Learning from Adverse Events Live Risk Assessment Patient Involvement in Risk Assessment Medicines As Required Psychotropic Medication High Risk Medicine Patient, Staff and Carer Education Medicines Reconciliation Safer Administration Processes Violence, Restraint and Seclusion Reduction Prevention and Management of Violence and Agression Training Debrief Following Restraint Restraint Monitoring 7

8 SPSP-MH Safety Principles Safety Principles: Communication at Transitions July 2016 Draft v0.7 Safety Principles: Leadership and Culture July 2016 Draft v0.7 Safety Principles: Risk Assessment and Safety Planning June 2016 Draft v0.7 Safety Principles: Medicines July 2016 Draft v0.9 Safety Principles: Violence, Restraint and Seclusion Reduction July 2016 Draft v0.10 8

9 Overarching themes Throughout the duration of the SPSP-MH, it has become apparent that there are a number of processes and procedures that cover the whole programme and are integral to the successful implementation, spread and sustainability of the Safety Principles: Communications Trauma Informed Care Approach Data & Measurement Service User, Carer, Family and Staff Engagement SPSP-MH Safety Principles Education and Training Legislative Framework Human Factors Interagency Collaborative Working Human Rights- Based Approach 9

10 Patient Safety Climate Tool The SPSP MH team facilitated development of the Patient Safety Climate Tool (PSCT) with Voices of experience and Support in Mind Scotland, based on the views and experiences of service users, carers and staff. The Patient Safety Climate Tool gives patients the chance to express their feelings and concerns about their safety while on a ward. This information allows services to make any improvements needed, resulting in a better patient experience of hospital care. Gordon Johnston, Public Partner, Healthcare Improvement Scotland The PSCT ensures that service users and carers are at the centre of their own care, and are able to highlight areas of positive care and where care requires improvement. It also provides a structure so that service users experiences can be recorded and used to bring about improvements for themselves and others. The PSCT is designed to ask about environmental, relational, medical and personal safety. Examples of themes from completed PSCTs have included the need for more information about medication and possible side effects, and positive comments about staff and their ability to deconstruct and help explain and offer support in order to interpret difficult situations. Date Time Name of ward How long have you been an inpatient in this ward? (please tick relevant box) Are you detained under the Mental Health Act? (please circle) Less than 1 week Between 1 week and 1 month More than 1 month Would rather not say Yes No Would rather not say Is this your first admission? (please circle) Yes No Would rather not say Under tick relevant box) How old are you? (please Gender (please circle) Male Female Please rate the following by placing a tick under the response that best fits with your experiences from strongly disagree to strongly agree 1 Strongly disagree 2 Slightly disagree 3 Neither agree or disagree 4 Slightly agree patient safety climate tool 5 Strongly agree X Not applicable 01 I usually feel safe in the day time. Comments It is a Scottish innovation that is leading the way in person-centred, safe delivery of care. 02 I feel safe in the communal areas. Comments 03 I feel safe during the period when staff change over shifts. Comments 04 If I have concerns about my safety, I would know who to go to. Comments 05 Sometimes I think there aren t enough staff to manage difficult events on the ward. Comments 10

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12 Service user and carer involvement Engaging service users, carers and families is essential to the work of the programme and is achieved through learning sessions, workstream development groups, delivery groups and the PSCT. Additionally, links and rapport have been made with a wide range of third sector service user and carers organisations who feed into the programme through being members of workstream development groups as well as in less formal ways such as catch-up meetings or attending localised third sector events. Including service users and carers as well as the third sector in the SPSP-MH is integral in ensuring the success of the programme of work, and that it is both appropriate and meaningful. This has been reflected in the increasing numbers of service users and carers that are attending both the national and regional learning sessions. The programme also has active service user and carer representation on the delivery group. At the most recent round of regional SPSP MH learning sessions, over 14% of delegates were service users, carers or third sector. 12

13 Taking a human rights based approach SPSP-MH has adopted this approach through using the PANEL principles (P participation, A accountability, N non-discrimination and equality, E empowerment, L Legality) working with partners such as the Scottish Human Rights Commission and See Me to ensure that service users rights are being upheld. Furthermore, mention is made of the positive impact of the SPSP MH in the Mental Welfare Commission report: The Scottish Patient Safety Programme Mental Health (led by HIS) aims to systematically reduce harm experienced by people receiving care from mental health services in Scotland, by supporting frontline staff to test, gather real-time data and reliably implement interventions, before implementing them across their NHS board area. Human rights are an overarching theme of the programme and the programme is actively considering ways to further embed rights-based approaches across their work. 1 1Human rights in mental health care in Scotland: A report on progress towards meeting Commitment 5 of the Mental Health Strategy for Scotland (published September 2015) 13

14 What does the data tell us? Existing nationally aggregated data gives a baseline and a route to comparison but it is the individual ward data that is showing real improvement. The approach and usefulness of the data being collected is constantly reviewed and there is communication around this with NHS boards on a frequent basis. There continues to be the flexibility to include additional approaches if it becomes clear that there are gaps and also to remove measures if these are clearly not helping to identify harm or assess whether the changes being made reduce harm. As of September 2016: 6 wards show a reduction in the percentage of patients who self harm 17 wards show a reduction in the rates of physical violence, and 13 wards show a reduction in the rates of restraint. 14

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16 Next steps SPSP-MH began in 2012 by testing and prototyping ideas and did not seek to cover every area all at once. What has been learned in the first 4 years of the programme (phases one and two) is that incremental and small scale testing with spread at the appropriate pace and with local and national support have been the areas where real and sustained improvements have taken place. With this in mind, SPSP-MH will look to adopt a similar approach as Phase three of the programme is designed. Given the potential scale of Phase three, it is noted that certain areas of work will require prioritisation and, as with the current programme, will continue to be delivered through the following workstreams that were established during the first two phases of the programme: Communication at Transitions Leadership and Culture Risk Assessment and Safety Planning Medicines, and Violence, Restraint and Seclusion Reduction. A key message from our stakeholders was to see what evidence and lessons learned from the previous 4 years could be taken across to new areas of work. With this in mind, we have been working with stakeholders from across the broad spectrum of mental health in Scotland to discuss the feasibility and appropriateness of this. The result was that we would develop a prototyping year of Phase three that continues with the same workstreams but also that we would design and develop an agile programme that has the flexibility to meet needs as new areas come on board. We will also be taking into account the new Mental Health Strategy: Mental Health in Scotland a 10 year vision (to be published by the end of 2016). The new areas of Phase three of SPSP-MH fits in appropriately with the proposed new mental health strategy framework and priorities to transform mental health care in Scotland. 16

17 In the prototyping year, we will encourage NHS boards to continue to build on the success to date in Phase two areas whilst at the same time identifying local priorities across Health and Social Care Partnerships and considering in particular: CAMHS Community Older Adult Services, and Perinatal Mental Health. It should be noted that these areas are not exclusive and should there be a particular area that would benefit from the application of quality improvement methodology to support harm reduction then this should also be considered. At present, one area that is being actively looked at is the redrafting of the Patient Safety Climate Tool for use in learning disability services. This is being carried out in conjunction with NHS Fife and Voices of experience. The core approach of SPSP-MH (service user, carer and staff engagement, broader learning networks and using the Model for Improvement) will be complemented by other approaches such as the use of campaign models. An example of this is that SPSP-MH will be supporting the work of Equally Fit in reducing physical health inequalities with those suffering from severe mental illness along with Support in Mind Scotland, See Me and Bipolar Scotland. 17

18 Conclusion SPSP-MH is at a key point. As we come to the end of Phase two of the programme, as this report has demonstrated, there is ongoing and excellent engagement across Scotland and promising improvements in key outcomes within individual sites and potentially across the country. Allied to this the Safety Principles are being developed which, we anticipate, will be the ongoing focus of work within inpatient services across Scotland. The challenges that we now face are the consolidation and ongoing focus on work within inpatient services, with consequent improvement in safety. There is already considerable interest, engagement and enthusiasm for the extension of the programme into a variety of areas as outlined in this report. Dr David Hall, Clinical Lead, Scottish Patient Safety Programme for Mental Health 18

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20 You can read and download this document from our website. We are happy to consider requests for other languages or formats. Please contact our Equality and Diversity Advisor on or Edinburgh Office Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Glasgow Office Delta House 50 West Nile Street Glasgow G1 2NP spsp.scot