Embed Size (px)
Citation preview
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 Unit
28 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• Happines
s• Identity
Social• Valued
roles• Relationshi
ps• 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 miss
Limited service in acute care
No documented process for nursing staff
Urgent referrals were ad hoc
Non urgent referrals not seen until discharged into the community
Review of pathway
Identified need to review current pathway for emotional wellbeing in acute care
Appointment of an additional psychologist
Allocated weekly sessions by on acute wardAble 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 Questionnaire
All recognised that emotional wellbeing was important
Only 40% patients were asked about their emotional wellbeing
Main barriers to asking patients about emotional wellbeing were
CommunicationExperience, 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
Implementation
6 mths funding from the BCCN for 0.6 WTE psychology assistant
Consulted with staff to adapt the tool
Training sessions with staff
Assistant psychologist ward based to help withImplementation 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 5
Patient reassessed weekly
If patient triggers then OT completed distress thermometer or seen by psychology assistant
Referral to psychologist if needed for assessment, intervention and follow up
Psychology 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
Evaluation
Repeat staff questionnaire in October (at 6 mths)
Numbers screened
Reasons for not screening
Number of referrals to psychologist
Appropriateness of referrals
Patient questionnaire in January 2013
Future
Funding extended for a further 6 mths
Results of evaluation
Adapt tools and pathway if necessary
Develop nurse link worker
Develop the cognitive screening pathway
Group sessions on ward for patients and carers
Any Questions
Thank you for listening
Contacts
Dr. Dominic Crowley:
Dr Amanda Campbell:
Sonia Jenkinson:
