Welcome The Clinical In-Reach Project Bev Piper, Clinical Lead

Who are we? The Physical Health In-Reach Team consists of two Registered General Nurses Based within on a large Mental Health Hospital Site within the Later Life Unit Look after Long Term Physical Health Conditions to minimise transfer to the ‘acute’ trust 2 x general nurses, employed by community trust provider (BCH) rather than AWP Collaborative between BCH and AWP

Why are we here? The team was created in response to; Safeguarding concern on one of the wards Clinical Commissioning Group audit Project funded by Bristol CCG

When did we start? The team commenced work on the Coppice unit 14th March 2016

Key Performance Indicators (KPI) Reduce avoidable admissions to acute mainstream hospital Identify and reduce unavoidable A&E/Urgent Care contacts Monitor District Nurse / OOHrs / GP / Primary Care contacts Improve patient flow through care pathways Improve mental health practitioners physical health knowledge, skills and competency Support and improve discharge planning processes The main KPI was … K&S improved amongst – nurses, doctors, pharmacists, students, and unregistered practitioners Contributing toward supporting learners – junior doctors and nurses

How have we done against the KPI? Reducing Transfers to the Acute Trusts: Reduced avoidable Acute hospital admissions Zero in the past 6 months Reduced Acute hospital admissions by 66% This has been achieved by undertaking 39 “prevention of hospital admission” visits Is it worth adding the potential cost saving? £400 per day! 39 x £400 = £15,600 per day in an acute hospital bed

How have we done against the KPI? Mental Health Practitioners L&D: Four wound care study days across AWP (120 staff) COPD and use of inhalers workshops at hospital base Ward based microteaching sessions: pressure ulcers, catheter care, use of safety devices, hypoglycaemia Opportunist 1:1 teaching sessions Would be good to add in examples of the opportunistic teaching sessions – for example EOL care Do you want to add in something about Role Modelling – for example, care of the dying patient and wound care?

How have we done against the KPI? Care Pathways: Wound Care End of Life Care Catheter Care Pressure Ulcer Prevention

Challenges Continue to monitor delayed discharges but limited inroads into this Reasons: Lack of care packages available Lack of specialist residential and nursing home placements Is it worth adding the potential cost saving? £400 per day! 39 x £400 = £15,600 per day in an acute hospital bed

Additional Benefits for AWP: Work closely with AWP Physical Health Team Help inform AWP polices, procedures and training Support the adult wards (acute, PICU and rehabilitation) on the Bristol hospital sites Supervise and assess trainees / pre-registered nurses practice In addition to the original KPI … Work closely with AWP PHC team = Attend Trust PHC meetings and provide your specialist knowledge, TEP/EOL care work Help inform AWP P, P & training = Wound Care / Diabetes May also want to add plans for central dressing store?

Why does it work so well? Team comprises of ‘general nurses’ with experience of managing Long Term Physical Conditions, Wounds and Catheterisation Able to meet own CPD needs through the Community Trust Provider and the South West Physical Health Leads Group We have successfully embedded ourselves within the team

Where do we see this going? The team would like to see the pilot: Increased to cover the whole BNSSG CCG at the Coppice (Bristol, North Somerset and South Gloucestershire) Increased to cover the whole of Callington Road Hospital Site (eight wards) Sarah would like to see this service replicated on all our main hospital sites or to have trust wide general nurses!

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