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Implementing a Person Centred Model of Care in Adult Acute Mental Health In-patient Services

Graham McLaren
Service Development Manager
Submitted Date: 06/04/2011
Review Date: 15/11/2010

Local Area
Forth Valley
Care Setting
In-Patient Setting
Care Group
Evidence Base for Practice
The new model is based on the NHS Quality Improvement Scotland (QIS) Standards for Integrated Care Pathways for mental health (December 2007) and QIS Best Practice Statements for Admission to adult mental health in-patient services (March 2009). The main objectives of the Model were to improve continuity of the patient journey between community / hospital / community, and to improve the patient experience of acute admission services.
Quality assurance/impact of practice
Some broad outcomes from the test include patients stating that it is easier to access staff and they have more time to spend with them. Patients also stated they were learning new skills and the ward was more relaxed. Staff reported satisfaction with the separation of functions as this allowed more time for face to face patient contact leading to stronger therapeutic relationships. Staff also stated that their roles were clearer due to the separation of functions, indeed, there was wide support for this aspect of the Model. Specific outcomes include increased compliance with the QIS Best Practice Statements on admission, risk assessment, therapeutic engagement and discharge planning. The number of therapeutic activity groups increased by 220% over the period of the test compared with a similar period during the preceding year. The range of activities also increased to include specific psychologically based interventions with support from Clinical Psychology and Behavioural Psychotherapy.

The outcomes of the evaluation have been discussed at the Adult Mental Health Care Group and key recommendations have been agreed. Such as:

• Reduction in beds from 53 to 43
• Continuation of separation of acute and recovery beds
• Improvement in information regarding therapeutic activities
• Reduction in number of consultants from 7 to 5
• North and South sectorisation of nursing staff within acute and recovery areas
•Collection of data to continue
Practice Summary
A new model of care for Adult Acute In-patient Services was tested in one of the two acute admission wards in Forth Valley between September 2009 and April 2010. The new model is based on ICP Standards and QIS Best Practice Statements and focuses on improving continuity of the patient journey and the patient experience.
Practice Detail
Six working groups were set up to review and improve the admission process, risk assessment and management, care planning, therapeutic engagement, discharge planning, and pathways for patients with more specialist needs such as eating disorders and alcohol detoxification. The Model also separated the acute/assessment function and the recovery/pre-discharge function by creating distinct areas in the ward for each purpose. This has allowed staff and patients to focus on specific needs more effectively. It has also enabled much greater and more effective engagement with patients in a wider range of therapeutic activities.
The main challenges involved securing wide buy-in from the clinical team, in particular Consultant Psychiatrists, and changing the physical environment in the test ward to accommodate the separation of clinical functions. The former was not fully achieved but was aleviated by an extensive process of consultation throughout.
Additional Comments
Wide consultation and involvement, particularly of service users and carers, has been crucial in developing the Model and implementing changes. This has been most valuable when users and carers have been members of the various working groups developing each part of the pathway. The value of user and carer comments has maintained momentum throughout the process. The impact of changing one part of the service must be considfered in relation to the other parts that have an interface, hence the need to plan ahead and view the acute in-patient pathway as only one part of the patient journey.

In practice, for this peice of work, the QIS Best Practice Statements have been of much more practical use that the ICP standards although, as the latter are implemented, we will see how they compliment each other.
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