Releasing Time to Care Mental Health
Cree West Ward
NHS Dumfries & Galloway
Case Study
Cree West began implementing Releasing Time to Care in January 2010. 18 months later, we have completed the 3 foundation modules and are working on the process modules.
Increasing Direct Care Time
Our baseline Direct Care Time
Improving Patient Safety & Reliability of Care
Our Measures Board has tracked the number of Hospital Acquired Infections, Fall Rates, Aggression & Violence, and Complaints, which have now been changed to Medication errors/omissions.
Following is a table of aggression and violence.
In June 2011, no incidents of aggression & violence recorded at all.
Improving Efficiency Of Care
We looked at the number of times a trained nurse had to contact the nurse from previous shift to clarify whether or not they had administered a medication, as they had not recorded appropriately, leaving a blank box.
A safety cross was put in place and for the first month of recording the following results were found: -
In June- 9 omissions were noted and recorded. This was unacceptable and in order to reduce this, a checklist was implemented, and changes of practice.
Nurse administering would continue to wear RED tunic alerting others not to disturb, noticed placed on clinic door informing others that the
Medicine round is taking place and not to disturb. A 2nd nurse to assist in bringing next patient to clinic to prevent administrator leaving area as our patients can be lost and confused and require this level of guidance. Also the following check list put into practice at front of Kardex :-
DATE / MEDICINEROUND / NURSE DISPENSING / NURSE CHECKING / COMMENTS
Since Cree West commenced this chart, 1 omission has occurred but the nurse checking picked this up but unfortunately the administrator had already left ward and finished shift, therefore 1 omission recorded. Staff have now ensured the checking will take place prior to administrator leaving ward.
Improving Patients Experience
Process Module – Meals
In Cree West, our patients can be very disorientated to time, place and person due to a high percentage of them diagnosed with cognitive impairment. Therefore, meal times are more therapeutic and beneficial if structured, and all staff available to assist. Orientation, encouragement and persuasion can be key skills at these times and any interruptions or distractions can lead to the patients either not sitting down to take any of their meal, leaving in the middle of a meal or in fact, becoming agitated, hostile and disrupting others at meal times. Obviously these factors can have a detrimental effect on physical wellbeing, nutritional intake and hydration. We also aim to maintain social and practical skills at meal times.
We were finding that medical staff, visitors, social services staff, estates etc were coming to the ward or phoning at designated meal times, and this was not conducive to the environment or the situation.
Therefore, the activity team engaged staff in making LARGE bright red posters for all external doors, notifying visitors to the ward that the patients were enjoying their meals and not to disturb unless urgent. We contacted IT department and our phones can be put onto a recorded message but giving an alternative contact in the case of emergency. Our new ward booklet, which is given out to friends and relatives on admission included our protected meal times, and all medical staff updated. This allows us to give full attention to all our patients at each mealtime and offer them the best chance of enjoying their meal and maintaining or improving their nutritional intake.
We have also linked up with Dementia Champions and tried out the RED PLATE initiative. However, since our tables are of a dark coloured wood, the red was found not to stand out very well therefore we are currently purchasing a trial sample of suitable crockery which will hopefully be recognisable to our patient group and enhance their dietary intake.
Improving Staff Wellbeing
We used the RTC Thermometer in Cree West to measure staff morale in August 2010.
Cree West Staff Morale
Cree West%
Snapshot / J Brilliant / K Alright / L Rotten / Brilliant / Alright / Rotten
Aug-10 / 31 / 29 / 0 / 52% / 48% / 0%
Feb -11 / 60 / 32 / 0 / 73% / 39%
We then repeated this in February 2011 and plan to repeat again in August 2011.