Embed Size (px)
Citation preview
The State Hospital
Intensive dietetic support in high secure care
– what are the outcomes?
Frances Waddell
Lead Dietitian
The State Hospital
The State Hospital
About us
It is part of the NHS in
Scotland and provides care for
patients from Scotland and
Northern Ireland.
The State Hospital
Patients 2015/6
140 beds, approx 120 occupied.
77% of the patients are ‘restricted’.
The majority have a primary diagnosis of schizophrenia.
The average length of stay is 6 years, ranging from one month
to over 30 years.
Average age 42 years.
(Data annual report for TSH 2016/7).
The State Hospital
Original site pictures
In 2008 the State
Hospital signed
the contract to
begin the
transformation
The State Hospital
Entrance to our new site!
The State Hospital
In 2011 the
new State
Hospital was
complete!
Statistics
• Approx 83% patients are overweight or
obese (Jun/Oct ‘17)
– Increasing trajectory since records started in
2003 (Max 93% in Dec 14)
• Over 40% have Metabolic syndrome
– Higher rates in those on Clozapine
• Around 20% have diabetes (mainly type 2)
– Majority developed following admission.
The State Hospital
Framework for supporting health
• National Policy
• Obesity Route Map (SGov)
• Food Fluid and Nutritional Care Standards
(HIS 2014)
• Food in Hospitals (2010)
• Healthcare Retail Standard (2017)
• Physical Activity Taskforce – guidelines.
• NICE/SIGN/WHO/
The State Hospital
Framework for supporting health
• Physical Health Steering Group (PHSG)
• Supporting Healthy Choices (SHC) consultation.
• Dietetics
– 1:1, groups, Weight Management Plan, clinics,
• Psychological support
– 1:1, groups
– Recent role of trainee health psychologist
• Physical activity
– LDP target
– Facilities and assessment
The State Hospital
The State Hospital
Sports and Fitness
Sports hall and Gym.
Activities throughout
the day, and at
weekends.
Physical Activity
• On ward – games, pacing, patio area
• On hub – Wii, pool, hub Gym, pacing
• In activity centre – gym, weights, gardens,
animal feeding, arts and crafts, woodwork.
• Grounds access – 5 levels
• Levels of activity represent most achieve
low to moderate levels PA,
• (New activity recording – session today)
The State Hospital
Interventions
• Dietetics (WMP – Priorities)– 1:1
– Small group interventions
– LCD/Orlistat
• Groups– ‘Slim and trim’ – ‘Weight Watchers’ style group
– Healthy Living Group (HLG) – Psychology, Dietetics
and sports/activity staff
– Healthy Eating Group (HEG) – OT led
The State Hospital
Intensive Support Group (1)
• What did we do?
• 5 patients
• 1 dietitian
The State Hospital
Intensive Support Group (2)
• Baseline anthropometrics (weight and waist
circumference) taken
• A diet history was originally taken to identify what the
patient was currently consuming
• Identification of areas of the diet which could be improved
• Suggestions for dietary changes were agreed together with
the patient and reviewed at each patient review
• Physical activity was assessed and goals given to improve
activity levels
• Review intervals were agreed with the patient
The State Hospital
Intensive Support Group –
Outcomes (3)
• Patient’s weight and waist circumference were monitored
at each review.
• All 5 patients had a BMI >40kg/m2 at the start of dietetic
intervention and only 1 patient remained with a BMI
>40kg/m2 at the end.
• Patient reviews carried on for between 1 ½ to 4 months,
depending on the patient.
• Weight loss success was influenced greatly by patient’s
motivation and also how active they were. All patients
were given support and advice on increasing physical
activity in conjunction with dietary advice to help promote
weight loss.The State Hospital
The way forward?
• Challenges with this approach
• Maintenance
• Equity of service
• MDT support
The State Hospital
The State Hospital
Considerations
What do you do?
What works in your area?
What can we all change doing?
Workshop
Group 1
• Identify the challenges with
this approach and possible
solutions?
• 10 mins debate and ideas
• 5-10 mins feedback
Group 2
• Blue Skye thinking –
supportive outcomes (not
considering any
barriers/challenges), what
could we do to achieve
targets and improve physical
health?
• 10 mins debate and ideas
• 5-10 mins feedback
The State Hospital
