1. Delivering physical health care on a PICU following a serious adverse incident
1 year on: lessons learned and future plans

2. Background Haven Ward is a 12 bed mixed sex PICU in Dorset
Female ward opened Jan 2017
Many issues during first few months of opening such as staff
vacancies including Ward Manager position
We had a serious adverse incident on the ward April 2017
Subsequent investigation highlighted issues regarding management
of physical health complaints on the ward 1

3. Key issues
Very high co-morbid physical health problems, especially with females, and in some cases the physical health symptoms required greater input than the mental health symptoms
Staff did not have the required training to meet this demand and many had only a basic understanding of physical health problems and how to assess, treat and manage. Staff were misdiagnosing physical health issues as behavioural.
CQUINS: we were inputting the information but not always doing anything with it
Patients being transferred to local general hospital for fairly routine problems
Poor links with primary and secondary care 2

4. What we did in the first 6 months…
Tried not to panic
Began process of identifying areas where there was deficit in knowledge and developed a training programme (using QI methodology)
Implemented staff training, attempted to match skill set of HCAs in general hospitals
Began process of changing ward culture around physical health
Started a physical health clinic, initially twice a week
Made sure information from CQUIN audit was being followed up
Hired RGN to help run clinic and to help asses, treat and manage issues
Attended conferences and looked to learn from other organisations 2

5. Initial problems we encountered...
People panicked
Very high acuity on the ward, short staffed and a lot of agency staff,
no consistency in care delivery
We had a plan but weren’t able to fully implement
Clinic for 2 days a week was not enough
RGN struggled to develop and integrate role on the ward.
Role of RGN on the ward de-skilled staff
Difficult to shift prevailing attitudes and ward culture 1

6. Where we are now
Staff are now confident in taking physical observations and assessing physical health complaints
Physical health clinic run 5 days a week, CQUIIN outcomes are monitored and followed up
The ward has a physical health team, who take the lead in ensuring any learning from incidents is shared and training implemented
Staff are able to take blood, do ECGs, manage wounds, use NG tubes, and know when to refer to primary & secondary care services
All patients have individualised physical health care plans which includes escalation plans in case of deterioration. These are co-produced and have input from specialists where applicable
Ward has access to a GP, as well diabetic and asthma nurses, every week
We are now able to manage some physical health incidents without having to transfer to a general hospital 2

7. What next? 2

8. Admission to a mental health inpatient ward should be seen as an opportunity to improve that person’s mental AND physical health.
Our vision on Haven Ward is to provide evidence based treatments for people with complex mental and physical health problems who also require a safe and secure environment. 2

9. Document Name
What next?
Pivot the ward away from being solely about the management of violence and aggression to the management of complex physical and mental health problems
Ensure there is a member of the physical health team on duty 24/7 so we can provide a physical health ‘clinic’ day or night
Change the title of Mental Health Support Workers to Nursing Assistants / Health Care Assistants
Continue with ensuring majority of staff can take blood, do ECGs etc
Carry on learning from mistakes 1

10. Lessons learned: Don’t panic
Make sure you are doing the basics right each and every time
Have a plan and be ready to change and adapt as you go along
Ward culture is as important as its knowledge base
Hiring an RGN is not the answer to all your problems
It is better to have lots of people able to deliver single individual interventions than one person who can do them all
Physical health emergencies don’t always occur Monday to Friday, 9 to 5 and they don’t occur in a vacuum
It takes time
Attending the Safety Collaborative can save lives… 2

11. Any Questions? …. 1