The State Hospital

Physical Health Assessment in The State Hospital

Karen Burnett APIC / Learning & Development

& Allan Burnett

Senior Rehab Instructor Sports & Fitness

The State Hospital

INTRODUCTION

The State Hospital

ABOUT US

The State Hospital is one of four high secure hospitals in the UK.

It is part of the NHS in Scotland (since 1994) and provides a national service for Scotland and Northern Ireland.

The State Hospital

ABOUT USAs a Special Health Board is accountable to Scottish Ministers through the Scottish Government.

There are 140 high-secure beds for male patients requiring maximum secure care: 12 specifically for patients with a learning disability.

The State Hospital employs around 700 staff.

The State Hospital

ABOUT PATIENTS 2013/14

77% of the patients are ‘restricted’.

The majority have a primary diagnosis of schizophrenia.

The average length of stay is 7.2 years, ranging from around two months to over 40 years.

The State Hospital

ABOUT PATIENTSAll patients are male - The women’s service closed in 2007/08 in line with the national plan for no high secure provision for females.

The average age is 41 years.

The State Hospital

OLD TO NEW!!

In 2008 the State Hospital signed the contract to begin the transformation

The State Hospital

In 2011 the new State Hospital was complete!

The State Hospital

PATIENT ACTIVITY

There are seven purpose built patient activity centres within the Skye Centre:

Atrium (i.e. social club / hobbies)Craft & DesignPatient LearningPrimary Care (i.e. Health Centre) Sports & FitnessWoodcraft

Gardens & Pet Therapy

The State HospitalThe State

Hospital

Health Centre

The Health Centre aims to meet and support most primary healthcare requirements of patients.

The State Hospital

HEALTH CENTRE

• Admission Bloods • ECG• Optician • Dentist• Podiatrist

BBV assessment by APIC

The State Hospital

SPORTS & FITNESS

Offer many varied sports and activities throughout the day, in the evenings and at weekends.

The State Hospital

PHYSICAL ASSESSMENT PROCESS

Patient Admission Pathway Variance Analysis Tool

What is it?

The State Hospital

NURSING INTERVENTIONS

Day of admission

• Complete particulars of admission and pass to Health Records

• Complete Observation Level plan in PMVA section of RiO

• Complete Blood Borne Virus risk assessment on RiO

• Physical examination completed on RiO and forwarded to Health Centre (including neurological examination & general medical history completed)

• Initial admission risk assessment tool completed on RiO (as per PMVA Policy)

• Carer/relative successfully contacted

The State Hospital

BY DAY 7

• Nutritional Screening Tool Completed on RiO

• Information Booklets (i.e. Patient Info, Hosp Info, Section Info, MWC Info, etc) explained and given to Patient - in a relevant and understandable format.

The State Hospital

NUTRITIONAL SCREENING TOOL

Why must we Nutritionally Screen Patients?

– National Standards (Scotland 2003)– Recommended as good practice (BAPEN

2003)– To be able to manage their nutritional care

appropriately– To manage any risks associated with their

nutritional care– To provide optimum nutritional care to

support their recovery.

The State Hospital

NST SECTION 6

MANAGEMENTGRID

SCORE 0 1-2 3-5 6 or above

RISK Minimal Risk Low Risk Medium Risk High Risk

ACTIONNo action

required, routine care

Observe, Healthy

Eating Diet

Referral to Dietician Set up weight trigger points

Urgent Referral

to Dietician

SCREENING Annually IF ADMISSION PATIENT

SCORES 0 RESCREEN IN 3

MONTHS.

Quarterly Monthly Monitor and review weekly

The State Hospital

DAY 14

• BEST-Index Assessment Completed on RiO(+ Care Plan updated)

• PECC Nursing Assessment Completed on RiO(+ Care Plan updated)

• Complete LUNSERs/GASS and pass to Health Records(if approp, e.g. if on anti-psychotic medication)

• Nutritional Care Plan completed

The State Hospital

BY DAY 42

• Admission fitness assessment completed

• Dietetic report completed on RiO and MDT informed Dietician discusses content of report with patient prior to Admission Case Review and log conversation in RiO Progress Notes

The State Hospital

PHYSICAL ACTIVITY

The State Hospital

ADMISSION PHYSICAL ACTIVITY PATHWAY

Initial Sports & Fitness assessments completed: -PARQ, Fitness assessment, Motivation & goals assessment

Hub fitness room induction completed

Drop-ins to Sports & Fitness

Skye Centre induction completed

Referred to Sports & Fitness and allocated sessions

Sports & Fitness induction completed

The State Hospital

PHYSICAL ACTIVITY REFERRAL FORM

Referral discussed at Clinical Team

Meeting – decision made to attend Sports & Fitness

Refused – Referral returned to Key worker with explanation

Approved – Referral sent to Sports & Fitness

Referrals Committee -Discussed at

meeting

Placement within Sports & Fitness

Decision regarding best programme for patient – 1:1 sessionsGroup sessionsWard activitiesOutside gyms

Patient stops attending activity

Self referral / Drop-in

Patient refuses to interact

Referred to Clinical Team

12 month assessment

Patient interviewed by

member of Sports& Fitness team

The State Hospital

THE STATE HOSPITAL LDP 2013-2016 TARGET

• National Target of 30mins x 5 days per week

• The State Hospital target of30mins x3 days per week

The State Hospital

SPORTS & FITNESS

TIMETABLE Monday Tuesday Wednesd

ayThursday Friday

0915-1130

Specialised sessions

Football Closed Specialised sessions

Closed

Lunch

1300-1430

General session

Fitness suite

Fitness suite

Fitness suite

General session

1445 -1630

Bowling Volleyball

Course work/ hub work/ fitness assessments

Fitness suite / training

Team/individual sports/coaching

General referred patients – various activities

The State Hospital

POSITIVE ACHIEVEMENTS

• Sports Leaders Award• Olympic Games & Commonwealth• Sportsman's Dinner & Award

Ceremony

The State Hospital

CHALLENGES

• Motivation – Patients• Competing with other disciplines &

activities e.g. Psychological therapies, OT sessions, shop

• Resources• Old sports routine

The State Hospital

THE WAY FORWARD 2015

• Ensuring Physical Health is everyone's responsibility

• Running within the hospital grounds• Cycling• Walking routes• Physical Activity Leaflet• Collaborative working • Trainee health psychologist Health

Improvement Model

The State Hospital

WHAT DO YOU DO?