Embedding shared decision making in practice, learning from aqua (1)
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Shared Decision Making & Self-management Support
Brook HowellsDr Harni BharajEmily LloydRachel Bryers
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• 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
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The House of Care Model
Empowered
patients
Engaged
professionals
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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
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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
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Explaining Choice, Options,Risks, and Benefits
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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
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The power of effective communication
Harnovdeep S Bharaj
Consultant Physician
Bolton Diabetes Center
Royal Bolton Hospital NHS FT
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Let’s start by talking about Hayley.
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‘SO WHAT ?’
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Admissions, showing minimal differences, Further detail work needs to be carried out on reasons for admissions, to understand where best to focus interventions.
Apr-1
2
May
-12
Jun-
12
Jul-1
2
Aug-1
2
Sep-1
2
Oct-12
Nov-1
2
Dec-1
2
Jan-
13
Feb-1
3
Mar
-13
Apr-1
3
May
-13
Jun-
13
Jul-1
3
Aug-1
3
Sep-1
3
Oct-13
Nov-1
3
Dec-1
3
0
2
4
6
8
10
12
DKA Admissions Age 16-24
AdmissionsAverage
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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.
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Apr-1
2
May
-12
Jun-
12
Jul-1
2
Aug-1
2
Sep-1
2
Oct-12
Nov-1
2
Dec-1
2
Jan-
13
Feb-1
3
Mar
-13
Apr-1
3
May
-13
Jun-
13
Jul-1
3
Aug-1
3
Sep-1
3
Oct-13
Nov-1
3
Dec-1
30
5
10
15
20
25
30
35
40
45
50
Percentage of DNAs for Adolecence Diabetic Clinic April 2012 to December 2013
DNA%Average
Pe
rce
nta
ge
of
Mo
nth
ly D
NA
s
MI Training in August, and ap-plied to clinic
Consultation model altered after attending MI training & Trial of Text reminders
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Apr-1
2
May
-12
Jun-
12
Jul-1
2
Aug-1
2
Sep-1
2
Oct-12
Nov-1
2
Dec-1
2
Jan-
13
Feb-1
3
Mar
-13
Apr-1
3
May
-13
Jun-
13
Jul-1
3
Aug-1
3
Sep-1
3
Oct-13
Nov-1
3
Dec-1
30
5
10
15
20
25
30
35
Number of DNAs Diabetic Adolescence ClinicApril 12 - December 13
DNADNA Average
Nu
mb
er
of
DN
As
pe
r m
on
th
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RESULTS
Number of DNAsApril 2012 – December 2012 140
Number of DNAs April 2013 – December 2013 106
24% fewer DNAs in 2013 since starting on the collaborative
Number of DNAsAugust 2012 –December 2012 71
Number of DNAsAugust 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!!
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Emily Lloyd
Patient Ambassador
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Presented by: Rachel Bryers - Team Leader St. Bartholomew’s Intermediate Care UnitDate: 4.03.14
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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
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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
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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.
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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
•
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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?
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Discharge Planning
• Peter’s views, wishes and choices around discharge were identified.
• Therapist’s recommendations were made
• Discharge plan jointly agreed.
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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.
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Following discharge……
• Feedback from District Nurses• Involvement of Emergency Assessment Team• Case conference held• Feedback from family
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Conclusion
PETERThe 6
C’s
CARE
COMPASSION
COMMUNICATION
COURAGE
COMPETENCE
COMMITTMENT
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Any Questions?
• For further information contact• Rachel Bryers• Advanced Practitioner/ Therapy Team Manager• ST Bartholomew’s Intermediate Care Service• [email protected]• Tel 0151 489 8724
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