Quality summary report: Injury Prevention for Carers

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1 Quality summary report: Injury Prevention for Carers CLCH Quality Report Jan Dec 2011 Service exact name Injury Prevention for Carers Based at 215 Lisson Grove NW8 and 64 Victoria Address line 1 Street SW1 Address line 2 Town/city London County London Postcode No. beds NA Website Main telephone Completed by Approval Louise Turpin-Clifford Professional Lead for Occupational Therapy Melinda Shepherdson Clinical Specialist Injury Prevention Marina Tempia and Ann Duncan Associate Directors for Adults Portfolio 1

2 CLCH Quality Report 2011 Summary report for Injury Prevention Directorate Adults 1 Service area Injury Prevention Service for Carers Boroughs Barnet Kensington & Chelsea Hammersmith & Fulham Westminster CQC statement of purpose for this service Purpose: The purpose of the Injury Prevention Service for Carers is to prevent injuries and promote the good health amongst unpaid carers who are at risk of injury or have suffered an injury through caring for someone. We are doing this by: Training carers in the best and safest way to move and handle the person they care for Providing carers with education on how to prevent musculoskeletal injuries, for example principles of back care Providing specialist moving and handling equipment and training to carers, for example a standing hoist and specialist sling Providing carers with education and advice on stress management techniques Providing carers with health promotion education and advice, for example benefits of exercise and diet and nutrition Referring carers to other services that may be of benefit, for example musculoskeletal outpatients physiotherapy, Carers Network Westminster and respite through Westminster Carers Service Scope: There are 6 million unpaid carers within the United Kingdom.

3 It is estimated that: carers save the nation 87 billion per year 1 within our lifetime 60% of us will become carers people providing high levels of care are twice as likely to be permanently sick or disabled 3 million carers juggle work with caring responsibilities A recent nationwide survey of 2000 carers 2 found that: 75% of carers felt that their health was worse as a result of the strain of caring 95% of carers covered up that their own health was suffering in order to continue with caring 24% stated they frequently felt unable to cope with their day-to-day duties due to the physical and emotional stresses of their caring role Within Westminster it is estimated that there are 16,600 carers. 3 Location: The service is located within the WRRS north and south offices based in Westminster. These are at Frampton Street NW8, and City Hall SW1. Intervention is provided both individually and in groups, in people s homes and community venues. Access: Access to our service is through the Single Point of Referral currently based at 215 Lisson Grove. 1 Valuing carers - Calculating the value of unpaid care (Carers UK/ Leeds University, 2007) 2 1,997 declared carers took part in the Carers Week survey between February and March Census 2001

4 Overall summary of quality performance and next steps A number of measures were taken over to assess and improve the quality of the Injury Prevention Service for Carers. 1) Annual audits of referral rates, demographics, ethnicity and gender of carers continue to be conducted and reviewed within the Injury Prevention for Carers Steering Group. 2) An Injury Prevention Outcome measure was developed and trialled to gain baseline information on initial interview. Questions cover the primary areas of intervention including Health and Pain; Lifting and Handling; Stress and Support. Once discharged Outcome Measure 2 is implemented on the discharge visit, or posted with the PREM at the end of each month. If Outcome Measure 2 has been returned, Outcome Measure 3 will be posted 6 months post discharge. As a result of a review of these some changes were made to the outcome measure questionnaire and improved in late A report on the initial results of this will be available after April Safety Overview We aim to make our service as safe as possible at all times. We are supported by The Injury Prevention Service for Carers Steering Group, which meets every 12 months and comprises of representatives from Carers Network Westminster, Westminster Carers Service and Westminster Rehabilitation Service. Our staff have had extensive experience in diverse areas of practice and bring a wealth of skills to the Injury Prevention Service for Carers. Such diversity and experience improves the quality of care for carers and those they care for. Each member of staff has a training and development plan each year to maintain and develop their skills and knowledge base. All staff have yearly appraisals. The Clinical Specialist Occupational Therapist is a member of the National Back Exchange, and together with the Band 7 Physiotherapist attends relevant

5 study days to ensure best practice guidelines are kept up to date with and peer support is received. Key achievements this year Key results We identified the following safety improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) There were no specific safety actions developed for this service last year. Referrals are prioritised as urgent, standard or routine. As the service needs to see carers who are often looking after people with high dependency needs the therapists need to ensure that they are using risk assessments and best practice moving and handling guidelines. There were no incidents raised by this service for the period January 2011 to December Safety Action Expected Named lead Improvement completion Actions for date 2012 To ensure risk assessment for carers and June 2012 Melinda staff is robust enough to prevent injury and Shepherdson help manage the person being cared for in a safe environment Staff will have regular supervision, annual December MS PADR s and training plans 2012 Identify and provide appropriate training opportunities 2012/2013 Team Effectiveness Overview We aim to achieve the best possible outcomes for patients. To do this, we regularly check to see that we are delivering care and treatment according to

6 best practice standards, and we increasingly look to measure and improve clinical and patient reported outcomes. Key achievements this year We identified the following clinical effectiveness improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) Strengthen results of clinical and patient reported outcomes Actions 2011: Development of a consistent approaches to data collection in particular in relation to patient and clinical reported outcomes. The Injury Prevention service uses their own developed outcome measure which has been discussed below and is reviewed with clients at 6 to12 months post discharge. Actions 2011: Engage with IT to identify and implement a consistent system for recording/data processing of clinical and patient reported outcomes. The service currently manages its own IT systems however the need has been identified to improve these systems. Action 2011: Hone a basket of outcomes measures to specific service areas to ensure measures are used consistently across CLCH Achievements 2011 Review and further development of Outcome Measure Part 1, 2, 3. Consistent implementation of Outcome Measure 1 and 2 Commencement of routine mail out of Outcome measure 3, six months post discharge Outcome measures Baseline information is gathered on initial interview through use of the Injury Prevention Service for Carers Outcome Measure Part 1. Questions cover the primary areas of intervention including Health and Pain; Lifting and Handling; Stress and Support.

7 Once discharged Outcome Measure 2 is implemented on the discharge visit, or posted with the PREM at the end of each month by the rehabilitation assistant. At times this is not appropriate due to death of person being cared for, language barrier, or the carer disengaging from intervention. If Outcome Measure 2 has been returned, Outcome Measure 3 will be posted 6 months post discharge. If Outcome Measure 2 has not been returned it will not be sent. These outcome measures have been implemented since the commencement of the service however a formal report has not been completed due to difficulty interpreting and comparing the data from Part 1 and 2. As a result of this, the outcome measure questionnaires were reviewed and improved in late It is planned to prepare a formal report in March 2012 pending return of Part 2 and Part 3 questionnaires. Information gathered will assist in the evaluation of interventions and future service delivery and development. Key results Patient Reported Outcome Measures (PROMs) In addition to Outcome Measure 1, 2 and 3, development of goal based templates was undertaken in 2010 and 2011 to work towards CLCH goal based outcome measures. This work was reviewed by the previous WRS clinical lead Occupational Therapist and Physiotherapist, however further development has been on hold due to the management restructure and reduction in capacity of staff. Given the health promotion based nature of service intervention within the Injury Prevention Service, utilising GAS goals is likely to be therapist led rather than client led. The Injury Prevention Service team at present feel that implementation of GAS goals for carers will be a paper based exercise rather than improving carer outcomes and service interventions. It is hoped that goal based outcome measures can be reviewed in 2012 and a decision on moving forward with these can be taken. Clinical Outcomes (see achievements section) 2011 Outcome Measures OM1 completed 68 OM2 received/completed 18

8 (Note: OM2 sent 30) OM3 received 4 (Note: OM3 sent 7) A report following the outcome measure bespoke in Injury prevention is expected in March This service did not have NICE guidelines that it measured itself against in this year. Plan: An identified NICE champion in the team will be forwarded relevant NICE guideline in 2012 to ensure compliance at appropriate level. They have access to all guidelines as they with the Rehab service and attend service meetings. What the patients say about the outcomes of their care and treatment Showing the right way to bend when supporting and helping the person to get off the chair, bed or the bath. Personal input relevant to my mother and me. Home visit enabled my mum to benefit from the training in comfort and without difficult journey. Ability to make a phone call in the future for special equipment when needed The demonstration of the skeleton as to how the back can get injured when lifting in the wrong position. The things she taught me to look after my father Clinical Effectiveness improvement actions Everything was explained to me and fully understood Action To continue to conduct annual audits and report back to steering group and agree on change implementations Expected Named completion lead date 2012 MS To complete a report on comparison of Part 1, 2 and 3 of the outcome measures and report back to the steering group 2012 MS

9 To further investigate practicalities of implementing GAS goals in line with CLCH 2012 MS Experience Overview Key achievements this year We care about treating everybody with kindness, dignity and respect at all times. Satisfaction surveys were first implemented by the Injury Prevention Service for Carers in September In March 2008 the procedure was altered so that the surveys were consistently mailed out once a month by the rehabilitation assistant. This process has resulted in a higher response rate than previous methods of implementation. This information has been reviewed and reported on annually, and where possible the service has been guided by this feedback. In April 2011 the format of the survey was altered in line with CLCH standards. It is now implemented through Freedom Health. Group Feedback The Injury Prevention Service for Carers group program is planned to run three times per year for 6 weeks. In the final group an informal feedback session is conducted, and the results compiled. For those carers unable to attend the final session, a feedback form is mailed out to them by the rehabilitation assistant. This information guides changes to the group program throughout the year. The feedback will continue to be summarised in the annual report. A question is included for carers who only attended one or two sessions. It is hoped the information gathered will identify reasons why they did not return to the group and assist with making the group sessions more inclusive and relevant. In 2011 only 2 group programs were conducted due to low numbers. We are awaiting the feedback forms from the last group which concluded in November Patient survey Patient surveys (known as Patient Reported Experience Measures PREMs)

10 results Summary of results for core patient experience measures (Aug-Dec 2011) Question Result for this service Trust-wide average % patients/carers rating overall experience good or excellent % patients saying they were definitely involved in planning their treatment % patients saying they were always treated with dignity & respect % patients saying they definitely understood explanation 82% 93% 82% 56% 83% 92% 92% 88% % patients satisfied with waiting time 83% 74% Interpretation of PREM results PREM methodology Our current procedure is for the rehabilitation assistant to mail out a PREM (and for some people a PROM) at the end of each month to discharged carers. A prepaid envelope is enclosed for the forms to be returned to City Hall (SW1). The returned PREMs are sent to Freedom Health by the rehabilitation assistant. Groups: In the final group an informal feedback session is conducted, and the results compiled. For those carers unable to attend the final session, a feedback form is mailed out to them by the rehabilitation assistant. This information guides changes to the group program throughout the year. The feedback will continue to be summarised in the annual report. A question is included for carers who only attended one or two sessions to ascertain why they did not attend all the sessions.

11 Number of PREM s posted to carers 32 Number of PREM s received 16 (2 of which are not in standard CLCH format therefore not collated in report). All participating carers looked after an adult/older adult. PREM volume targets Total Number of patients who responded to a PREM 16 Total new referrals 41 % of new referrals who responded to a PREM 39% Target % of respondents Target achieved? As many as possible Yes Compliments and Complaints Patient user groups and focus groups Other qualitative feedback There were no complaints raised against this service for the mentioned period All compliments were gathered from the PREMS and thank you cards received by the service. None None What the patients say What we did well: The feeling that I was understood and that I wasn t alone. I encountered great sympathy and kindness thank you. Excellent communication skills, very understandable person, ability to

12 listen and understand a person whose English is not her first language Emotional support and understanding Friendly, efficient and capable. Group programme not too big. We felt like we were treated as friends not patients/service users. J did everything she could to accommodate my needs appointments to suit me, at home it was a huge help. Everything that N did for us was amazing. The amount of delegation she had and her patience was so great. She tried so hard and brought us many things to find the right thing to help my daughter and me. She went out of her way to help us. Thank you N you are a great human being. What we could do better: Follow-ups visit, training as appropriate. Regular exercise session cover Patient Action Expected Name experience completion d lead Improvement date Actions Satisfaction surveys will be reviewed and reported on January 2013 MS annually Improve access to data and reports by utilising April 2012 MS Freedom Health website Ascertain reasons why some carers do not attend all group sessions and report on annually Prepare a report on why carers do not want to attend a group program December 2012 MS December 2012 MS

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