Embedding shared decision making in practice, learning from aqua (1)

Shared Decision Making & Self-management Support

Brook HowellsDr Harni BharajEmily LloydRachel Bryers

• Holistic care

• Collaboration

• Patient-centred care

• Partnership

• Personalised/individual care

• Choice

• Effective treatment

• Preference sensitivity

What is it all about?

Social; interactions with family, friends,

workmates

Psychological; reactions, thoughts, feelings

Biological; bodily symptoms

The House of Care Model

Empowered

patients

Engaged

professionals

Person-centred, coordinated care

What is being shared in SDM?

Clinicians

• Diagnosis• Cause of disease • Prognosis• Treatment options• Outcome

probabilities

Patients

• Experience of illness• Social circumstances• Attitude to risk• Values• Preferences

AQuA Experience To Date

2011/12 2012/13 2013/14•Awareness Raising & Engagement with members

•3 SDM Master classes

•Conference with NHS NW

•Secured NHS England implementation Programme

•Networking

•Delivered NHS England implementation Programme.

•SDM Collaborative with 33 teams – largest National Implementation

•Trained 699 clinicians across 60 training sessions

•Developed a range of patient and health professional resources

•Co-developed a new measurement tool - SHARED

•Over 500,000 A3Q leaflets distributed

•National Web Exs

•SDM/SMS Collaborative with 30 teams

•Trained 350 clinicians across 30 training sessions

•Validated the CollaboRATE tool with Dartmouth College

•MI Training – Demand outstrips supply

•New non NW organisations embedding A3Q & requesting training

•Only UK organisation implementing & embedding SDM & SMS

•Over 6,000 patient data points

Explaining Choice, Options,Risks, and Benefits

Patients – Our Greatest Asset

• How can you work with patients/carers/relatives to co-design changes?• How can you work with patients/volunteers to provide peer support/decision

support to patients?• Can patients/carers/relatives give information about the experience of each

decision?• Capturing the patient experience - case studies

The power of effective communication

Harnovdeep S Bharaj

Consultant Physician

Bolton Diabetes Center

Royal Bolton Hospital NHS FT

Let’s start by talking about Hayley.

‘SO WHAT ?’

Admissions, showing minimal differences, Further detail work needs to be carried out on reasons for admissions, to understand where best to focus interventions.

Apr-1

2

May

-12

Jun-

12

Jul-1

2

Aug-1

2

Sep-1

2

Oct-12

Nov-1

2

Dec-1

2

Jan-

13

Feb-1

3

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

0

2

4

6

8

10

12

DKA Admissions Age 16-24

AdmissionsAverage

DKA Admissions 16 – 24 Year Olds

Number of Admissions.April 2012 – Dec 2012 46

Number of Admissions.April 2013 – Dec 2013 45

No Difference in admission rate for this group!

Total of 106 admission episodes during the period of April 2012 to December 2013 for 48 patients:

A total of 6 patients accounted for 40.5% of the total admission episodes.The same 6 patients also accounted for 48% of the occupied bed days for this group of patients.

Apr-1

2

May

-12

Jun-

12

Jul-1

2

Aug-1

2

Sep-1

2

Oct-12

Nov-1

2

Dec-1

2

Jan-

13

Feb-1

3

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

30

5

10

15

20

25

30

35

40

45

50

Percentage of DNAs for Adolecence Diabetic Clinic April 2012 to December 2013

DNA%Average

Pe

rce

nta

ge

of

Mo

nth

ly D

NA

s

MI Training in August, and ap-plied to clinic

Consultation model altered after attending MI training & Trial of Text reminders

Apr-1

2

May

-12

Jun-

12

Jul-1

2

Aug-1

2

Sep-1

2

Oct-12

Nov-1

2

Dec-1

2

Jan-

13

Feb-1

3

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

30

5

10

15

20

25

30

35

Number of DNAs Diabetic Adolescence ClinicApril 12 - December 13

DNADNA Average

Nu

mb

er

of

DN

As

pe

r m

on

th

RESULTS

Number of DNAsApril 2012 – December 2012 140

Number of DNAs April 2013 – December 2013 106

24% fewer DNAs in 2013 since starting on the collaborative

Number of DNAsAugust 2012 –December 2012 71

Number of DNAsAugust 2013 –December 2013 40

43.5% fewer DNAs during this period once Motivational Interviewing, Style of Consultation altered!

Will need to be monitored monthly to see if this is a sustained trend!!

Emily Lloyd

Patient Ambassador

Presented by: Rachel Bryers - Team Leader St. Bartholomew’s Intermediate Care UnitDate: 4.03.14

Introduction

• St Bartholomew’s Intermediate Care Unit is a 20 bedded unit in Huyton, Knowsley.

• Collaborative relationship between the charitable home and 5 Boroughs Partnership NHS Foundation Trust

• Wanted to review the discharge planning process with a view to increasing patient engagement and clarifying expectation of all involved

Aims

• Increase the patients involvement in the care planning and discharge planning process

• Identification of the patients goals on admission

• Reduce the length of stay

• Increase patients satisfaction

• Increase confidence in decision making – both patients and staff

Case Study

• Peter was admitted to St Bartholomew’s Intermediate care Service for a period of intensive rehabilitation.

• On admission he was provided with written and verbal information regarding the service and the Shared Decision Making Project.

Therapy Intervention

• Initial Assessments were completed and his therapy goals were agreed with him.

• Following an assessment of the home environment a meeting was held with Peter to discuss his options and agree the discharge plan.

• This was done using tools we produced ourselves and the AQuA 3 Questions

•

3 Questions

1) What are my options?

2) What are the pros and cons of each option ?

3) How do I get support to help me make a decision that is right for me?

Discharge Planning

• Peter’s views, wishes and choices around discharge were identified.

• Therapist’s recommendations were made

• Discharge plan jointly agreed.

Right to autonomy v Protection

• Peter asked to see the therapist- changed his mind • Therapists ability to manage this- Understanding and

implementing The Mental Capacity Act 2005.• Tools developed to increase confidence in discharge

decisions when managing complexity and risk.

Following discharge……

• Feedback from District Nurses• Involvement of Emergency Assessment Team• Case conference held• Feedback from family

Conclusion

PETERThe 6

C’s

CARE

COMPASSION

COMMUNICATION

COURAGE

COMPETENCE

COMMITTMENT

Any Questions?

• For further information contact• Rachel Bryers• Advanced Practitioner/ Therapy Team Manager• ST Bartholomew’s Intermediate Care Service• rachel.bryers@5bp.nhs.uk• Tel 0151 489 8724