Improving physical healthcare for people with serious mental illness (SHINE Project)
People with serious mental illness, such as schizophrenia and bipolar disorder, have a significantly reduced life expectancy and a higher prevalence of physical health disorders than the general population.
Assessing the physical health of patients when they are in hospital offers an opportunity to identify risk factors for developing conditions such as cardiovascular disease or diabetes and provide advice and support on services that can be accessed on discharge. Unfortunately this is rarely done for patients with serious mental illness when they are in hospital, despite numerous national guidelines recommending such an approach.
Central North West London NHS Foundation Trust (CNWL), one of the largest providers of acute and community mental and physical healthcare has been working with NIHR CLAHRC Northwest London on a Health Foundation funded project to use quality improvement methods to develop and implement a tool to ensure all patients admitted to hospital have their physical healthcare needs met based on the use of the JBS3 Score as a calculator, which estimates an individual’s lifetime risk of a developing cardio-vascular disease and provide a basis for discussing with patients how their risk can be reduced. The systematic approach to quality improvement developed by CLAHRC Northwest London has been used by healthcare professionals, managers and patients to better understand care processes, develop and test interventions and engage with stakeholders.
Through the use of the Action Effect Method, the project team were able to identify a shared aim and articulate the programme theory that underpins the interventions and activities (http://qualitysafety.bmj.com/content/early/2014/10/15/bmjqs-2014-003103.full).
Process Mapping the care pathways associated with admission were developed to analyse current practice and identify where improvements could be made and interventions introduced. An initial audit of recording of physical healthcare parameters identified the need for a more robust and streamlined assessment and recording system.
Using the principles within ‘Measuring for Improvement’ methodology weekly measures have been established to assess the uptake of the assessment tool. The data will be captured on the Web Improvement Support for Healthcare (WISH), developed by CLAHRC Northwest London, which provides real-time analysis of data using statistical process control and mechanisms for collating information relating to the PDSA cycles and project activity (http://www.sciencedirect.com/science/article/pii/S1532046414000999).
Ensuring people with a lived experience of serious mental illness are involved as full members of the Project Team and the Advisory Board to ensure all perspectives are considered and has led to the co-production of a patient held physical health booklet as a tool for shared decision-making around physical health. The booklet uses a traffic light system to explain risks and enable patients to take some responsibility for improving their physical wellbeing. Finally the project team have been provided with the ‘Long Term Success’ tool, designed by CLAHRC Northwest London to support the team to reflect on progress and identify challenges to sustaining improvements in the clinical setting.
Update: Physical Healthcare Plan
The development of the physical healthcare plan, a crucial part of the intervention to improve physical healthcare, was led by a group of team members with experience of using mental health services. Whilst involvement and inclusion of team members with lived experiences was much broader than just the development of the plan, this was one of the main impacts of user involvement in the project. The physical healthcare plans were designed to act as a record of the physical healthcare assessment, including specific parameters such as blood pressure, BMI, smoking status etc. plus their specific cardio-vascular risk score i.e. their risk of having a heart attack or stroke in the next 10 years. The physical healthcare plan was based on a number of existing tools that have been developed within the NHS or by voluntary organizations and charities but modified to provide Trust/patient specific advice. Depending on the results of the physical healthcare assessment the plan guides the discussion between the healthcare professional and patient to identify modifiable risk factors and appropriate self-care activities or support services such as health trainers or smoking cessation etc. that are acceptable. The plan is currently being given to patients on discharge, along with a completed medications patient-held plan and physical health advice booklet, designed specifically for use by mental health patients. To assess the uptake and utilisation of the plan the number of plans issued each week is being monitored.
For more information on the work please contact:
Liz Evans – Mental and Physical Wellbeing Theme Lead NIHR CLAHRC NWL firstname.lastname@example.org
Dr Bill Tiplady – Clinical Lead for CNWL SHINE project, Consultant Clinical Psychologist email@example.com