Danish Patient Safety Program for Mental Health. Simon Feldbæk Kristensen Danish Society for Patient Safety
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1 Danish Patient Safety Program for Mental Health Simon Feldbæk Kristensen Danish Society for Patient Safety
2 Session aim Danish healthcare system Why mental health? Brief overview of Danish Patient Safety Program for Mental Health Users and Carers Engagement Data and measurement Questions
3 Danish Healthcare - Tax based financing 103 DKR billions/year approx 10 % of GDP - Mental health: 7,5 billions DKR admissions mil. outpatient visits - Costs - Activity - Change in demographics - Coordination of care
4 Mental Health!? 4 People with mental health disorders have a life expectancy years lower than the rest of the population 20 times at risk of committing suicide mental health disorders are on the top 10 list of diseases that causes loss of healthy life years High rate of mechanical restraint compared to other countries
5 Life expectancy Blue: People with mental health disorders, Total pillar: All people Source: Danish Regions, 2011
6 Collaborative aim and topics 6 Aim: Reduction in mortality Reduction in harm within psychiatric care Create a platform for continues improvement
7 7 teams
8 Workstreams Four clinical workstreams Safe medication Physical diseases/comorbidity Prevention of and reduction in the use of mechanical restraint Suicide prevention Two organizational workstreams User and carer engagement Leading improvement work
9 Workstreams and timeline Medicines Physical Comorbidity Suicide prevention Restraint User and carer engagement Leading improvement work
10 Mechanical restraint (example) Physical environment Calm boxes Low stimulus room Physical activity 50% reduction of mechanical restraint within mental health services by 2016, without increasing other types of restraints (psysical interventions, medication) Patient and Carers involvement Skills, knowledge, attitiute Debrief monitorering Weekly patient forums Open conversation Management Supervision Safety care bundles Patient at center Language Clinical handovers
11 Users and Carers Low engagement High engagement Information Participation Influence Partnership Examples Users and carers part of the teams (team meetings, learning sessions) Medication med. reconciliation in partnership Friday café engagement with patients and professionals Safety board for patients
12 Data and measurement Medicines (examples) Outcome measures Process measures Intoxication Medical reconciliation Aim No intoxication 95 % Numerator Days between case Number of patients with all elements done Denominator Number of discharged patients
13 Data - I
14 Data - II
15 Data - III
16 Danish Patient Safety Program for Mental Health Three year Collaborative 7 units Four clinical workstreams Two organizational workstreams Etc.
17 What it really is A cultural journey A journey for and with users, carers and staff Better and safer care Mental Health!
18
19 Thank you!
20 Northern Ireland Quality and Safety Improvement Collaborative Mental Health Our journey
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22 Providing leadership in Patient Safety and Quality Improvement across Health & Social Care
23 What do we do? Promote Quality Improvement (QI) Engage staff Help design reliable processes & systems Facilitate standardisation/reduce variation Use data to uncover the real story
24 HSC SAFETY FORUM QUALITY IMPROVEMENT FRAMEWORK Unscheduled Care Community Care Maternity Care Paediatric Care Mental Health Primary Care Scheduled Care
25 MENTAL HEALTH, A KEY PRIORITY.
26
27
28 Suicide in N.Ireland UK UK UK suicide rate: 17/100,000 (male): 5/100,000 (female)
29 Male suicide in NI: 30% between yrs
30 Drivers for Change 1. The Bamford Review of Mental Health and Learning Disability (NI) 2. Royal College of Psychiatrists Audit of Schizophrenia 3. Northern Ireland Mental Health Service Framework 4. NICE CG RQIA Evaluation of the Service Provision for Physical Health Needs of people with a Mental Illness or Learning Disability 7. Regional Anti-Psychotic Prescribing Guidelines 8. ImROC Recovery Colleges 9. Media
31 Primary Drivers Secondary Drivers Interventions Prevention. Early Intervention Crisis Resolution NICE 123 Common Mental Problems Establish Primary Care Hubs Implement Revised Protect Life Psychological Medicine Person and Family Centred Care. Safe Evidence Based Care NICE Guidelines Psychological Therapies Strategy Research Mental Health CPD Framework Managed Care and Outcomes Framework Mental Health Research Collaborative Hope Opportunity Control Recovery Orientated Practice Consistency Wellbeing Experience Standardise Care Pathways IMROC Programme Physical Care Model(LESTER Principles) Effective High Intensity Services Acute High Intensity Care Model Specialist Service Model Standardise CRHT Services Acute Service Care Pathway High Intensity - Low Secure Service Model Specialist Service Model
32 No Decision About Me Without Me
33 Purpose Of Care Pathway
34 Who Is Care Pathway For?
35 STRUCTURE OF SAFETY FORUM REGIONAL MENTAL HEALTH (MH) COLLABORATIVE MH Advisory Group 1-2 senior staff from each trust Expert from all/some trusts MH collaborative Subgroup The combined core teams from all trusts (25-30 or more staff) Belfast Trust MH QI group Southern Trust MH QI group Northern Trust MH QI group SE Trust MH QI group Western Trust MH QI group 10 or more staff (4-6 core team and others) working on QI within each trust representing multiprof team and staff from front line to senior staff
36
37 Pre-work: August 2013 April 2014 Agreement at Strategic Partnership Group to begin QI Collab in Mental heatlh Letter to MH Leads August 2013 asking for rep. on Advisory Group (AG) 1 st AG meeting held August 2013 to identify areas of focus 2 nd AG meeting December 2013 areas of focus: crisis management and improving physical health needs 1 st stage driver diagrams developed for discussion LS Mental Health Collaborative The Journey Action Period 3 Tests of change Measurement Action Period 2 Action Period 1 Trusts to form improvement teams Identify area to begin improvement work Development Regional Driver Diagram Development of local driver diagrams? Identifying areas for change testing Refine Driver Diagrams Beginning tests of change Baselines Measurement
38 What are we trying to accomplish? Crisis Management AIM OF WORK The overall aim is to reduce harm to mental health patients by: Identifying Risk/Assessment Risk Management/ Planning DRIVERS: PRIMARY/SECONDARY Risk Screening Comp. risk assessment (currently under review) LEAVE FOR NOW Crisis Management Plan Care Pathway What specific changes can we make which will result in improvement? Risk Screen tool Comprehensive risk assessment tool Use of hand held notes (health passport) Management Plan < number of suicides? < episodes of self-harm? < number of visits/admissions to hospital? < number crisis presentations Communication Out of hours service Available information Recovery Colleges Telephone Help-line Trigger List Education Mental Health SBAR (see eg) Patient/Client and family/carer involvement Recognition of problems (signals) Education, awareness raising Link with out of hours service Signposting Patient information/education Availability of patient s info to family/carers Person Centredness awareness training RESTRAINT Is this separate box or part of another driver? Further discussion required
39 What are we trying to accomplish? DRIVERS: PRIMARY/SECONDARY What specific changes can we make which will result in improvement? PHYSICAL HEALTH NEEDS AIM OF WORK The overall aim is to improve the physical health and well being of mental health patients: < no. patients who stop smoking < no. patient who reduce smoking < no. mental health patients received health checks SMOKING (cessation and reduction) IMPROVED PHYSICAL CARE COMMUNICATION Stop smoking (pathway see eg NHS Health Development Agency) Weight loss and improved fitness Monitoring of antipsychotic medication Recognition and rescue of deterioration Information Between health and social care professionals Public health - campaign Access to services Family involvement Collaborative needs to agree interventions in this section WHAT CAN WE DO? Key worker Accessing services Use of hand held notes (health passport) Local Escalation Common pathways/ templates Key worker Mental Health Team (review patient s GP record) Training Patient/Client and family/carer involvement Education Patient information/education Availability of patient s info to family/carers
40 WHSCT: improved physical Health: - Antipsychotic medicatin - Deteriorating patients NHSCT: (a) Improved physical health (b) Crisis management in ED BHSCT: Crisis: patient experience and effectiveness of assessments in EDs SHSCT: Physical health SET: Crisis: stepped approach to promoting personal safety to reduce number crisis presentations by existing service users
41 % of Clinets seen idefined Response Times ED Response Times August % 90% 80% 70% 60% 50% 40% % seen in < 2HRS 30% 20% 10% 0% DATE Prompt and thorough assessment: Waiting time(s) in ED
42
43 BASELINE Baseline 56 Crisis presentations (known to team) April June Average 19 per month. Dashboard CYCLE 1 Cycle 1 July/August Staff trained in person centred practice July -18 CYCLE 2 Cycle 2 August/Sept Programme SQE to mirror learning set aims Aug-15
44 No. Crisis Presentations Month Day Presen tation OOH Presen tation Crisis Presentations 18 July August Monthly average Day 8 Out of hrs Apr-14 May-14 Jun-14 Jul-14 Aug-14
45 Physical Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug Lipid Plasma Glucose/HbA1C Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14
46 BP Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug Smoking Status Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14
47 BMI Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 ECG Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14
48
49
50 AND OUR JOURNEY CONTINUES Current work continues and progresses Culture Surveys: - in patient - Home Treatment - Community Teams Work with Regional Mental Health Core Care Pathway Regional measurement development? Work on restraint? Collaboration with colleagues
51
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