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

2. 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

3. 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

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

5. 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

6. 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

7. 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?

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

9. 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

10. 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?

11. 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

12. 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!

13. Thank you for listening
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