1. IMPROVING PRACTICE – QUALITY IMPROVEMENT
Improving Practice on Springbank Ward
Lee Davies Clinical Nurse Specialist July 2017

2. Outline Background to Springbank Ward Key initiatives
The current situation

3. Background Crisis Leadership – high turnover
Philosophy – risk containment, MHA, observations
Patients – institutionalised
Staffing – vacancies, burn-out and recruitment problems
Incidents – record levels

4. Incidents Average 88.2 incidents per month 2.9 per day
Up to 6.6 per day (October 2015)

5. Context

6. Mind shift Before After Rules Institutionalisation Risk containment
Fire fighting
Status quo
After
Values
Discharge planning
Positive risk taking
Nurturing environment
Ongoing change (Revolution!)

7. From Rules to Values Ward opens -> incident happens
-> some rules
-> incident happens
-> people get into trouble
-> new rules
-> new incidents….

8. The (unwritten) Rules Smoking hours - 9:30am (if all awake) - 11:00pm
Leave:
Returning to the ward from leave by 9pm
No leave after 11pm
No leave at crazy hours
No holidays
Rooms are locked in daytime hours.
Plastic cutlery and crockery
No alcohol
No drugs

9. The (unwritten) Rules Smoking hours - 9:30am (if all awake) - 11:00pm
Leave:
Returning to the ward from leave by 9pm
No leave after 11pm
No leave at crazy hours
No holidays
Rooms are locked in daytime hours.
Plastic cutlery and crockery
No alcohol
No drugs

10. Values
Respect
Recovery
Safety

11. Respect, Recovery, Safety
Patients attend the ward programme (70%)
Developed electronic attendance monitoring systems
Patients co-produce the ward programme
We listen to their feedback
Fobs for patients (if attending)
Drink responsibly (if appropriate)
Don’t do drugs

12. Respect, Recovery, Safety
Patients decide what type of leave is appropriate
Walk at 2am
Strawberry Fair
Cambridge Beer Festival
Greek islands and Tenerife!
Patients given the responsibility to behave appropriately
When coming back from leave
When smoking at night
Patients influence their environment
Decorating
Gardening
Patients set discharge dates

13. Positive risk taking Removal of long-term observations
Resisting pressures from ‘above’ to avoid risk.
Removal of sections of the MHA
Allowing patients to leave the ward at any point
Constant team discussions

15. Prejudice Staff Patient Manipulative Annoying Hopeless
“Hospitals make it worse”
“Not really ill”
“Psychological illness”
“Drugs don’t work”
“Social construct”
Patient
Bad
Worthless
Hopeless
“Not really ill”
“My fault”
“Your fault”

16. Nurturing environment
Staff support
Clinical Supervision
Reflective Practice
Case discussions
Educational activities
Away days
Change in staff attitudes and values
Impacts patient behaviour
As a result:
Increased recruitment
Increased retention
Recovery workers
Peer support worker
Only 3 vacancies
2 apprentices
1 recovery worker

17. Before… Averages 88.2 incidents per month 2.9 per day
Up to 6.6 per day (October 2015)

18. …and after. Averages 36.2 incidents per month (skewed) 1.2 per day
12 months of the lowest figures since the ward opened.

19. Context

21. and after…

22. Physical Intervention
Data available from 21/2/12 till 10/08/16
234 incidents of PI
143 required rapid tranquilization
Last rapid tranquilisation
25/06/15

23. Physical intervention
Year
Physical intervention
Rapid tranquilisation
2012 52 36
2013 57 45
2014 59 44
2015 64 18
2016 3
2017

24. The Future? Self-medication Outcome measures Research
Therapeutic community?
Ongoing change…

25. Any Questions?