Leading Better Care
Sharing Good Practice
NHS Board: Lothian
Ward / department / team: Regional Eating Disorders Unit (REDU), St John’s Hospital
Details of Improvement:
What was the particular problem that this case study isabout?
To develop a carers forum for families, relatives, carers and close friends of patients who have an eating disorder.
The REDU aims to provide intensive treatment for the patient from a wide range of disciplines; however the patients’ family and friends are often left with many questions regarding how to help and also feeling helpless.
How was this identified?
We felt that a carer’s forum might be beneficial as research shows in eating disorders; the illness does not only affect the person, but, has an impact on all members of the person’s family and close friends.
Through regular feedback from families, carers and relatives key themes identified included;families not fully understanding the rationale behind some decision making and issues regarding the sharing of nutritional information which could leave families feeling they did not know what the meal plan was or how to cope with things like portion sizes due to the difficult nature of the illness.
Therefore we felt there was a need to provide family and friends of our patient group with an opportunity to meet with staff and discuss how the illness was affecting them, and provide them with tools on how to cope with their relative both in hospital and out as this would be vital to help recovery. In return this would also benefit staff as it would fit in with other work streams including Delivering Better Care and Releasing Time to Care to provide safe, effective, person centred care using efficient staff resources to spend more time working on treatment plans with the patients and their families.
What were the implemented improvements (whattools/techniques did you use)?
Through regular feedback from families, carers and relatives using fast frequent feedback tools such as the ‘Dog and Rose’, also by using Emotional Touch Points and by carrying out Observations of Care.
Initially we sent out ‘Dog and Rose’ forms to all members of staff and patients and some family members. We then used Emotional Touch Point stories with both staff and patients. Observations of Care were also used where we observed patient/staff interaction and also patient/family interaction. By collating all the evidence and plotting it in the ‘Senses Framework’ it became very clear that it was not only ourselves that felt there was a need to include families in the treatment process, but also the other staff, patients and families.
We gathered evidence by sending out open ended questionnaires to get feedback from all parties to establish their thoughts on a parent/carers forum and what topics they would find useful. We utilised the ‘Dog and Rose’feedback forms to gain quick feedback as the form was simple and allowed the person freedom to put down their own thoughts and ideas and was not leading in any way.
We collected the evidence by altering the questionnaire slightly to make it specific to the group that were receiving it. We asked for them to be returned in a short period of time. We asked specific questions relating to topics, timing of forums and what they would find beneficial about a forum. Once we received the completed forms we looked for common themes and decided to run a pilot forum to see how it was accepted by all parties. The pilot forum took place April 2013 and it was very well received the outcome of which provided us with key theme topics for a carer’s forum. We also gathered feedback at the end of the forum to ensure that it met the expectations and needs for the parents/ carers.
In providing education we would hope that relatives would feel they had a better knowledge and understanding about eating disorders in general.
What is the situation now?
Implementation of a carers forum to providerelatives with a space where they can discuss how they were feeling and gain peer support from other relatives who may be going through the same situation or have done so in the past and also get support from professionals.
Improved communication resulting in much better informed patients, families, carers and relatives that enhances relationships between all.
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How is the change sustainable?
Benefits are immediately visible for staff, patients, relatives and carers. There is willingness and engagement from staff to participate in the carer’s forum. Regular feedback is integral to REDU through a variety tools and this will be ongoing therefore will enhance not only what we are already doing well but will also give us the platform to make any changes as required.
Measurable outcomes
What are the patient benefits?
Although in very early stages the multi-disciplinary team feel it will benefit the patients’ recovery and acknowledged that the relatives and carers play a huge part in helping recovery so by equipping them with coping tools to help them and support their relative, then they in turn would be able to identify relapse and reduce risk of crisis situations.
Other benefits include improved understanding and communication resulting in enhanced relationships and recovery, providing support both in and out of the hospital.
What are the staff benefits?
More efficient use of staff time/resources.
What are the organisational benefits?
Providing safe, effective person centred care.
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How did staff feel before the improvement/during theimprovement and after the improvement?
We felt that the outcome of this would impact on the health and well-being of patients/families by doing the following; it would help patients as families would have more of an insight into the nature of an eating disorder and what it does to a person. It would give families the tools to empower themselves rather than them feeling at times helpless when their relative was struggling to cope with thoughts or a particular situation. This would also benefit all parties as they would be able to get the support they needed and feel like the illness was more contained at home as well as in hospital as they would not have to do it solely on their own. We also felt this would help staff as it should reduce phone calls/face to face meetings for families looking for advice. It would also support the team’s decisions made with the patients’ best interests and recovery in mind. This would therefore give staff more time to work with patients individually on working on their individual issues and treatment goals. This would provide help/advice for the families themselves giving them support, education and practical assistance.
There was some anxiety initially about delivering the carer’s forum however with our knowledge, skills and expertise this quickly improved and our confidence grew. We now see this as the way forward for REDU.
What are the lessons learnt and what would you dodifferently next time?
We have learnt about several different tools we can use and adapt to enhance the caring experience for patients, staff and relatives. We have come to realise that even when you think you have received as much information from people as you could, through utilising these tools you can gain a lot more. This can help gain a valuable insight into thoughts and feelings of patients, staff and relatives. This therefore ensures as far as possible we are “getting it right” for everyone every time.
What plans are there to spread the improvement?
We plan to have regular forums and involve all current inpatient families and possibly families of patients who had been discharged in the past 6 months as at times patients may be readmitted for either relapse or to work on a specific area of recovery. All members of the multi-disciplinary team will be involved. Staff and families would be directly involved in the forum and patients would be asked for feedback as to how they felt it is helping their families e.g. are family more supportive at mealtimes, more understanding?
We will continue to seek feedback using the tools we have learnt about to ensure the forum is effective and that patients, relatives and staff are continuing to see a benefit from them.
Once established we hope to disseminate to other areas across NHS Lothian.
Contact information for case study
Denise HoxleySenior Charge Nurse/Laura Cumming Staff Nurse
Regional Eating Disorders Unit
St John’sHospital
West Lothian