The State Hospital Physical Health Assessment in The State Hospital Karen Burnett APIC / Learning & Development & Allan Burnett Senior Rehab Instructor Sports & Fitness

The State Hospital INTRODUCTION

The State Hospital ABOUT US The State Hospital is one of four high secure hospitals in the UK. It is part of the NHS in Scotland (since 1994) and provides a national service for Scotland and Northern Ireland.

The State Hospital ABOUT US As a Special Health Board is accountable to Scottish Ministers through the Scottish Government. There are 140 high-secure beds for male patients requiring maximum secure care: 12 specifically for patients with a learning disability. The State Hospital employs around 700 staff.

The State Hospital ABOUT PATIENTS 2013/14 77% of the patients are ‘restricted’. The majority have a primary diagnosis of schizophrenia. The average length of stay is 7.2 years, ranging from around two months to over 40 years.

The State Hospital ABOUT PATIENTS All patients are male - The women’s service closed in 2007/08 in line with the national plan for no high secure provision for females. The average age is 41 years.

The State Hospital OLD TO NEW!! In 2008 the State Hospital signed the contract to begin the transformation

The State Hospital In 2011 the new State Hospital was complete!

The State Hospital PATIENT ACTIVITY There are seven purpose built patient activity centres within the Skye Centre: Atrium (i.e. social club / hobbies) Craft & Design Patient Learning Primary Care (i.e. Health Centre) Sports & Fitness Woodcraft Gardens & Pet Therapy

The State Hospital Health Centre The Health Centre aims to meet and support most primary healthcare requirements of patients.

The State Hospital HEALTH CENTRE Admission Bloods ECG Optician Dentist Podiatrist BBV assessment by APIC

The State Hospital SPORTS & FITNESS Offer many varied sports and activities throughout the day, in the evenings and at weekends.

The State Hospital PHYSICAL ASSESSMENT PROCESS Patient Admission Pathway Variance Analysis Tool What is it?

The State Hospital NURSING INTERVENTIONS Day of admission Complete particulars of admission and pass to Health Records Complete Observation Level plan in PMVA section of RiO Complete Blood Borne Virus risk assessment on RiO Physical examination completed on RiO and forwarded to Health Centre (including neurological examination & general medical history completed) Initial admission risk assessment tool completed on RiO (as per PMVA Policy) Carer/relative successfully contacted

The State Hospital BY DAY 7 Nutritional Screening Tool Completed on RiO Information Booklets (i.e. Patient Info, Hosp Info, Section Info, MWC Info, etc) explained and given to Patient - in a relevant and understandable format.

The State Hospital NUTRITIONAL SCREENING TOOL Why must we Nutritionally Screen Patients? –National Standards (Scotland 2003) –Recommended as good practice (BAPEN 2003) –To be able to manage their nutritional care appropriately –To manage any risks associated with their nutritional care –To provide optimum nutritional care to support their recovery.

The State Hospital NST SECTION 6 MANAGEMENT GRID SCORE or above RISKMinimal RiskLow RiskMedium RiskHigh Risk ACTION No action required, routine care Observe, Healthy Eating Diet Referral to Dietician Set up weight trigger points Urgent Referral to Dietician SCREENING Annually IF ADMISSION PATIENT SCORES 0 RESCREEN IN 3 MONTHS. QuarterlyMonthlyMonitor and review weekly

The State Hospital DAY 14 BEST-Index Assessment Completed on RiO(+ Care Plan updated) PECC Nursing Assessment Completed on RiO(+ Care Plan updated) Complete LUNSERs/GASS and pass to Health Records(if approp, e.g. if on anti-psychotic medication) Nutritional Care Plan completed

The State Hospital BY DAY 42 Admission fitness assessment completed Dietetic report completed on RiO and MDT informed Dietician discusses content of report with patient prior to Admission Case Review and log conversation in RiO Progress Notes

The State Hospital PHYSICAL ACTIVITY

The State Hospital ADMISSION PHYSICAL ACTIVITY PATHWAY Initial Sports & Fitness assessments completed: - PARQ, Fitness assessment, Motivation & goals assessment Hub fitness room induction completed Drop-ins to Sports & Fitness Skye Centre induction completed Referred to Sports & Fitness and allocated sessions Sports & Fitness induction completed

The State Hospital PHYSICAL ACTIVITY REFERRAL FORM Referral discussed at Clinical Team Meeting – decision made to attend Sports & Fitness Refused – Referral returned to Key worker with explanation Approved – Referral sent to Sports & Fitness Referrals Committee - Discussed at meeting Placement within Sports & Fitness Decision regarding best programme for patient – 1:1 sessions Group sessions Ward activities Outside gyms Patient stops attending activity Self referral / Drop-in Patient refuses to interact Referred to Clinical Team 12 month assessment Patient interviewed by member of Sports & Fitness team

The State Hospital THE STATE HOSPITAL LDP TARGET National Target of 30mins x 5 days per week The State Hospital target of 30mins x3 days per week

The State Hospital SPORTS & FITNESS TIMETABLE MondayTuesdayWednesdayThursdayFriday Specialised sessions FootballClosedSpecialised sessions Closed Lunch General session Fitness suite General session BowlingVolleyball Course work/ hub work / fitness assessments Fitness suite / training Team/individual sports/coaching General referred patients – various activities

The State Hospital POSITIVE ACHIEVEMENTS Sports Leaders Award Olympic Games & Commonwealth Sportsman's Dinner & Award Ceremony

The State Hospital CHALLENGES Motivation – Patients Competing with other disciplines & activities e.g. Psychological therapies, OT sessions, shop Resources Old sports routine

The State Hospital THE WAY FORWARD 2015 Ensuring Physical Health is everyone's responsibility Running within the hospital grounds Cycling Walking routes Physical Activity Leaflet Collaborative working Trainee health psychologist Health Improvement Model

The State Hospital WHAT DO YOU DO?