Lister Big share

Geographical challenge Lister Stevenage Hertfordshire Harlow Essex Luton and Dunstable Bedfordshire St Albans Bedford

Big thanks to our current champions Lister Sandra Charlotte Amanda christine John Harlow Tina Luton and Dunstable Maggie Sharon St Albans Tibbi Randy and Arnold Bedford Deborah Rijo

Great Inroads met All units participating Everyone knows about it word has spread Part of our culture Patients /staff satisfaction

What were we trying to accomplish Promote patient independence by enabling them to be competent in haemodialysis tasks knowledgeable about their health as well as their disease

What is Shared Care? Shared care is not self care Patients in shared care can learn as they go along and at their own pace, doing as little or as much as they want to

What is a shared care programme? Gives patients control of their treatment while still working alongside healthcare professionals Evidence gathered from dialysis patients who have participated in their own care, show that they: Understand their treatment and condition. Gain confidence. Feel better in themselves.

Is shared care for every patient? May not be for everyone This is about patient choice! This is a patient, not nurse led programme Patients will influence each other Situations or attitudes may change over time

Barriers to implementation Staff shortages High sickness rates Skill mix Staff \ patient attitudes beliefs Resources Space in older units

The patients view

How do you feel you made the difference Slowly and persistently Listening but remaining steadfast Evidence and choosing champions Posters Flip charts Staff attitudes gradually changing and accepting concept taking ownership

The old ways The process inhibiting nurses' power Adib Hagbaghery et al. Human Resources for Health 2004 2:9  

Fight for change, but pick your battles wisely Rules for radicals You can’t make a difference without doing things differently Sometimes you break glass, sometimes you leave it the way it is and look through it Fight for change, but pick your battles wisely

Resource folders Ken has devised some resource flip charts

Encouragement

Simplifying posters

Peer support wasn’t working Good idea Very few volunteers although many do this role unconsciously

How did you expect to demonstrate improvements Introducing DOM’s Role

What I wasn’t keen on The 14 task idea it was a good starting structure and necessary for the Cquinn but Left other allied professions out Themes for the month such as tips dieticians phosphate control Fluid balance potassium Counsellors Taking control back strategies Motivational talks

Exercise Bike was too cumbersome and heavy Trying out simple alternative

Feedback from team Consistency required for patients Busy periods difficult Patients loose confidence if taking longer to learn Gradually you build on your achievements

What did you lean From Sheffield Days That we were doing well at a trust but we couldn’t get complacent That the Care support workers wanted to be involved just as much as the nurses and when they really got behind the message great things happened That just because you change something it might not make it better

What changes did you actually make Pdsa cycles 1 train one patient in a non shared care bay 2 to train 3 3 introduce more staff to shared care team 4 that these staff needed formal training 5 from listening to other units ideas coffee morning / booklet revision

Measurements of change Costing and health economics Nurses are sometimes intimidated by statistics and shy away from it get defensive as a knee jerk reaction Given the appropriate support and encouragement we can take it on board

Obstacles to shared care Communication between shared care staff and all staff members Perceptions and staff views on selected shared care pts for e.g. pts seem to elderly for shared care, and often staff tend to put these pts without notifying a trained shared care staff

What would you do differently More staff at the beginning Teaching sessions Staff allocated to one patient at a time Include research reg or stats person

What we want to do Shared care in pre dialysis Simple steps temp BP and weight Question? Will pre dialysis input make a difference when the patient starts dialysis Is it the earlier the better or too soon!

Nurses role Nurses must be a strong voice and through planning and careful monitoring can make improvements to the services provided to the patient Nurses must be accountable for clinical outcomes

Long term problems Keeping momentum when staff leave or Go on rotation or get promoted Reliance on few to “ do shared care”

Thank you