Health Promotion Service Physical Activity Pathway Ward ... learning... · Dec 13 – Jan 14 Lydia...

Health Promotion Service

Physical Activity Pathway

Ward Based Audit

Dec 13 – Jan 14

Lydia Jenner

Orthopaedic FY1 RIE

Physical Activity

Pathway Audit

Primary question: ‘Is the Physical Activity Pathway being used by Health Care Professionals on the wards?’

-Patients chosen at random on one of four orthopaedic wards

-Asked patients whether they had been asked about their levels of Physical Activity before by a member of the healthcare team

-If so; by whom? Had they found it a useful exercise? How long had the conversation lasted? And finally; had it made a difference?

Setting Audit carried out at the RIE Orthopaedic Wards (Trauma

and Elective)

Trauma wards (108 &109) – each 36 beds

Elective wards (208 & 209) – 24 and 36 beds respectively, often also used for trauma patients

Trauma wards – typical patient load: older age adults; fragility fracture (hip) multiple co-morbidities; approximate ward stay 4 to 14days

Elective wards – typical patient: middle age adults; elective joint replacement (knee); some co-morbidities (arthritis; diabetes; COPD); approximate ward stay 3-4days

Audit carried out over Christmas/New Year period – less elective patients; staffing levels reduced; less continuity of care

Results so far 31 sets of patient data collected so far; only small sample size!

Age range 29 – 87,

Mean age: 61.03

Male : Female ratio – 13:18

Percentage asked about Physical Activity levels: 9 patients (29%)

Therefore only 4 out of 31 patients asked about levels of PA during current inpatient stay.

9 Patients

4 - GP 3 - Physiotherapist 1 – Asthma Nurse (GP) 1 – Pre-op assessment

Cont. Out of 9 patients asked about PA; 8 were interested to

discuss PA and received brief advice/more thorough

intervention

Advice/interventions ranged in time duration from 2

mins to 15mins

Out of those 8; 6 patients intended to follow some of

the advice given to them to increase their levels of PA.

Feedback from Patients High level of interest from patients.

Patients were happy to discuss

Common patient perceived barriers to PA – age,

weight, co-morbidities (arthritis), un-aware of

availability of local facilities

Patient perceived barriers to Healthcare Professionals

discussing PA – time restraints, priorities.

Incidentally… Physical Activity Pathway not openly displayed on any of the

four wards

Staff unaware of PA pathway & minimum levels of activity/week

Impromptu poll of staff: 10 junior doctors

3 orthopaedic registrars

1 Medicine of Elderly registrar

1 MOE Nurse Practitioner

4 Orthopaedic Nurses

4 Physiotherapists

1 Pharmacist

Not one member of staff asked has used the PA pathway

Only one member of staff asked had heard of the PA pathway.

My Experience of using

the PA Pathway

-patients were generally interested and engaged in

conversation easily

-patients commonly stated co-morbidities as barrier to

being more active but were able to do at least one form of

exercise

-simple tool to use; exit pathways useful for patients who

are clearly disinterested.

Conclusion

High level of patient interest

Not being implemented on orthopaedic wards presently

Low level of staff awareness

Suggestions

Enrolling Junior Doctors

Opportunities to promote PA pathway to junior doctors:

-the ‘Shadowing week’ lectures at the start of FY1;

mandatory lectures for the new intake of junior doctors in

July.

-FY1/FY2 mandatory teaching – held once a week at

every hospital, include in the curriculum to promote to

current Junior Doctors

Suggestions cont. - Potential to include a few questions about levels of PA in

the Admission document

PLANNING AHP ROLL-OUT

Chris Kelly Health Improvement Senior

Kat Savage AHP EPR Project Lead

AHPs and Electronic Patient Records

Why EPR?

In line with NHS Scotland's eHealth Strategy, NHS Greater Glasgow and Clyde acute sector is moving to paperlite working

Work to date:

600 WTE

PT / OT Acute Staff

Estimated 359,393 Sheets

of Paper per Year

60,691 New Patients per

Year

120 Versions of

Documentation

8 electronic forms (eForms) shared documentation

23 word documents

AHPs and Physical Activity

AHP Directors Pledge:

“We will work with a range of partners to increase the level of physical activity in Scotland”

CEL

“NHS staff routinely highlight the importance of physical activity for patients in hospitals as part of their rehabilitation and for prevention of future

illness”

A Games Legacy for Scotland

"We want to inspire the people of Scotland to be more active. To take part in physical activity and

sport. To live longer, healthier lives."

What are we asking? Within the AHP Record of Care eForm, the physical activity question is

embedded. This eForm will be used during every inpatient Physio and / or OT

episode of care.

Training

• NHSGGC’s 1 hour generic Raising the

Issue

• Physical Activity topic bolt-on

– Health Scotland's Raising the Issue of

Physical Activity e-module

Benefits

• All staff will be asking the same

questions

• Shared documentation cuts down

duplication

• Signposting information available to all

online

• Plan to extract information to audit

number of patients who were asked the

question

Challenges

• Tackling knowledge and behaviour of

staff

• Measuring impact

• Training staff ahead of roll out of

electronic documentation.

Next Steps

• Train 600 wte Physio’s/OT’s

• Pilot template

• Create a data reporting mechanism to

allow for audit

Thank you!

Chris Kelly

0141 201 4956

Chris.kelly@ggc.scot.nhs.uk

Kathryn Savage

0141 201 1525

Kathryn.Savage@ggc.scot.nhs.uk

Promoting Physical Activity

in Palliative Care

Mandy Trickett

Macmillan Physiotherapist

Macmillan Day Care Unit,

Specialist Palliative Care Services, Dundee

mandy.trickett@nhs.net

Background

2007

2010

• Evidence?

• What was happening elsewhere?

• Scoped local exercise classes and other hospice exercise classes.

• E-networking UK and worldwide – benchmarking

• What did the patients want?

• Would it benefit the organisation?

Questions….

AHP Practice Development

Apprenticeship Scheme (Sept 2012 – 2013)

Aims : To support development of AHPs

• evidence based practice

• Improvement demonstration

• to develop AHP as leaders for practice development.

Philosophy:

Learn as you do through group based activities and practice based learning.

• Led by Dr Jacqui Morris,

• funded by CHPO (Jackie Lunday)

• Tayside Centre for Organisational Effectiveness

• MCN Lead for Nutrition

• supported by AHP directorate

Outcomes of interest

• Improve QOL

• Improve physical performance

• More patients seen in a group setting

• Patient centered approach

• Staff engagement in promoting physical activity

Methods Participants – all patients who attended April – Oct 2013

• 23 ½ hours video, focus group work

• All new patients screened using Scottish Physical Activity Pathway – referred to physiotherapy or given information.

Intervention –

• 8 week circuit based exercise class -

strengthening, cardiovascular, balance, flexibility exercises using evidenced based guidelines.

• pacing, planning, exercise diary, goal setting, relaxation, motivational interviewing Health Behavior Change.

Outcomes --

• Improvement tools used to develop and design the programme.

• Range of validated outcome measures used to assess change.

Improvement Tools

• Literature review

• Stakeholder communication

• Communication plan

• Project Definition statement

• Process Mapping – patient pathway

• Driver diagram

• Project plan

• Informing, Engaging, Consultation Plan (IEC)

23 1/2 hours, gained patient feedback - focus groups, flip charts, information leaflets, emotional touchpoints,

• Data collection

• Staff engagement – patient documentation

Results

• 18/89 patients took part in the exercise group.

• (cancer n=9, COPD n= 5, MND n=2, MS n=1, cardiac n=1)

• 50 % dropped out due to disease progression, 9 completed.

• 7/9 - increase in physical performance, Palliative Performance Scale and

QOL.

• 2 /9 - decrease in physical performance, Palliative Performance Scale but

QOL still increased.

• 3/10 - taking part in an exercise class was “important” to them.

• 7/10 - would prefer other types of activities such as walking, gardening or

Chi Gung to help remain physically active.

• Patients who completed, reported their general physical activity levels had

improved

• More patients were seen in a group setting

• Daycare staff became more pro-active in addressing patients activity levels.

Measureable outcomes - tested before and after the

exercise class

Benefits of the project

Patients Express their choices

Demonstrated benefit

Significantly more active afterwards

Equal access

Staff

Evidenced improvement and

patient centred care

Utilise time more effectively

Have feedback on patient choices

Organisation

Proof- evidence based, equally accessible and

effective

Person-centred approach

Increased use of resources

Group exercise

- evaluation

What is the situation now?

1 100% of all Macmillan Day Care patients have their physical

activity levels screened on admission and promoted in line with

Scottish Physical Activity Questionnaire/Pathway

2 Group exercise (circuit class) is available for all patients based on

need not diagnosis.

3 Patients are taught self-management skills such as pacing, planning

and goal setting to continue to remain physically active and

independent for as long as possible.

4 Next steps –

Walking programmes and Chi Gung (like Tai Chi) are now under

development for those who do not wish to or are unable to take part

in an exercise group but would like to undertake physical activity.

New IEC plan.

“You matter because you are you, and you matter until the last moment of your life. We will do all we can, not only to help you to die peacefully but also to live until you die.”

Dame Cicely Saunders

(founder of the modern hospice institute)

Thank you.

Closing Remarks

• Be a champion and raise awareness with your colleagues

• Lead by example through your own practice and physical

activity

• Use and promote the professional support tools available

• Link with your HPHS Lead, Physical Activity Lead and QI

colleagues to collaborate on projects

• Make sure you work is recorded and recognised

• Share your practice with professional peers and through

national groups

With many thanks to our collaborating national and local colleagues

who have supported, contributed to and influenced the work to date.

With particular thanks to:

- Event Steering Group and planning team

- All our presenters

- All our facilitators

- All delegates for their participation

- All marketplace presenters

- All those sharing work on our interactive wall

Please share your learning and reflections from today

with your colleagues, and signpost them to our resources.