Emotional Well Being on an Acute Stroke Unit

Implementation of a Mood Screening Pathway

Walsall Healthcare NHS TrustDr Amanda Campbell - Clinical Psychologist

Sonia Jenkinson - Lead nurse

Acute Stroke Unit28 bedded combined acute & rehabilitation ward

14.5 days average LOS – 45% discharged by day 7

420 stroke admissions per year

Integrated stroke service

Hyperacute, acute, ESD, rehabilitation, long term care

1.00 WTE psychologist across whole pathway

Life time psychology service

Why is emotional wellbeing important

Physical• Mobility• Sight• Dexterity

Mental• Confidenc

e• Happiness• Identity

Social• Valued roles• Relationship

s• Financial

stability

Stroke impacts on mood and social circumstance not just on physical systems

Emotional wellbeing can impact upon physical recovery

Effect not always apparent in acute stage

Early intervention can improve longer term outcomes

How things were 12 months ago

HADS tool (hospital anxiety and depression score) and SADQ-10 (stroke aphasic depression tool)

Assessed at 14 days Over 60% patients discharged before 14 days Poor uptake by nursing staff Carried out by OT’s – reactive and not proactive Not an ideal tool for acute patients, or patients with

aphasia or cognitive impairment Poor data collection

How things were 12 months ago

Referrals to psychology service:Hit and missLimited service in acute careNo documented process for nursing staffUrgent referrals were ad hocNon urgent referrals not seen until

discharged into the community

Review of pathwayIdentified need to review current pathway for

emotional wellbeing in acute careAppointment of an additional psychologist Allocated weekly sessions by on acute ward

Able to see patients on wardLiaise with nurses, doctors, physiotherapists, OT’s &

SLTProvide training and support for staff

Questionnaire undertaken by staff about perception of emotional wellbeing

Staff QuestionnaireAll recognised that emotional wellbeing was

importantOnly 40% patients were asked about their

emotional wellbeingMain barriers to asking patients about

emotional wellbeing wereCommunicationExperience, knowledge and confidenceWorkload

Inpatient Emotional Wellbeing Pathway

Depression Intensity Scale (DISC)

Score of 5 or 6 request Distress Thermometer assessment by OT

Stroke Aphasic Depression Questionnaire (SADQ)

Score 14-25 - Distress thermometer assessment

Score 25-30 - refer to Clinical Psychologist

Distress Thermometer

Implementation6 mths funding from the BCCN for 0.6 WTE

psychology assistantConsulted with staff to adapt the toolTraining sessions with staffAssistant psychologist ward based to help with

Implementation Prompt staffMinor interventions Collect data and monitor progress

Weekly support for the psychology assistant

How it works in practice

Nurses carry out DISCS & SADQ-10 on day 5Patient reassessed weekly If patient triggers then OT completed distress

thermometer or seen by psychology assistantReferral to psychologist if needed for assessment,

intervention and follow upPsychology assistant attends weekly MDT patient

reviews Data collected on stroke register and psychology

data base, will then be able to input data on SNAP at 6 mths

EvaluationRepeat staff questionnaire in October (at

6 mths)Numbers screenedReasons for not screeningNumber of referrals to psychologistAppropriateness of referralsPatient questionnaire in January 2013

Future

Funding extended for a further 6 mthsResults of evaluationAdapt tools and pathway if necessaryDevelop nurse link workerDevelop the cognitive screening

pathwayGroup sessions on ward for patients

and carers

Any Questions

Thank you for listening

ContactsDr. Dominic Crowley:

dominic.crowley@walsallhealthcare.nhs.uk

Dr Amanda Campbell: amanda.campbell@walsallhealthcare.nhs.uk

Sonia Jenkinson: sonia.jenkinson@walsallhealthcare.nhs.uk