Project leads: Dr Elvan U. Akyuz & Declan Phelan Project team: - - PowerPoint PPT Presentation

Improving Physical Health Monitoring of City & Hackney Assertive Outreach Service Patients

Project leads: Dr Elvan U. Akyuz & Declan Phelan Project team: City & Hackney Assertive Outreach Service Project sponsor : Dr Susham Gupta

AIM Improving physical health monitoring (blood tests, weight, ECG, BP) of AOS patients to 80% from November 2014 to May 2015. BACKGROUND

• Severe mental disorders (SMI) are associated with poor physical health with increased

rates of CVD and T2DM and premature mortality.

• Improving physical healthcare in people with SMI is a priority for ELFT and NHS

England.

• The iatrogenic effects of some psychotropic medications contribute to this, which

needs regular monitoring.

• National Audit of Schizophrenia (NAS2) 2014 was “although monitoring of physical

health risk factors were about average in ELFT, it was still below and was particularly poor for monitoring of glucose control and lipids”

Driver diagram

PDSA cycles

Weekly team meeting: record blood tests + ECGs Patients to be taken to HUH for ECG + Blood tests Joint GP review for patients with complex physical health needs. Record & share the monitoring using CPA forms & RIO codes Utilise newly arrived pod machines Group Spreadsheet by Allotted Care Coordinator Request physical health summaries from GPs

Pod

Data

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 Percentage of Total Patients Monitored Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 Weight 49% 62% 76% 78% 81% 79% BP 47% 59% 74% 75% 83% 86% Bloodtest 36% 44% 58% 61% 66% 70% ECG 34% 39% 45% 45% 53% 61%

C&H AOS Physical Monitoring

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% BP Weight BT ECG

Comparison of Physical Health Monitoring between AOS and Forensic AOS in April 2015

AOS Forensic AOS

71% 74% 20% 24% 28% 15% 0% 10% 20% 30% 40% 50% 60% 70% 80% Smoker Overweight Hypertension Diabetic Hyperlipidemia Abnormal ECG

Results of C&H AOS Physical Health Monitoring - Mid-May 2015

Learning

• The complexities of physical health monitoring of SMI patients are more

challenging than at first thought.

• Effective leadership, collaborative team work, routine recording of the

results and improved communication between primary and secondary care increased the AOS physical health monitoring.

• The creation of a local database updated at weekly clinical meeting with

monthly presentation on the progress can help embed this into daily practice.

• Increasing physical health monitoring of its patients has implications on

C&H AOS’s operational functioning, training and supporting infrastructure

• Clear understanding between the Trust and CCGs around shared care

protocols.

Next Steps

• Pod should be used - helpful screening tool - 86% uptake (26/30patient).
• The development of an electronic physical health assessment form.
• The data to be stored on a team shared drive.
• To improve monitoring, interpreting and communicating of ECGs - service

level agreement.

• Involvement of patients /carers.
• Providing Information leaflets on physical health.
• Group Psychoeducation
• Consider free lunch or payment for an incentive as a last resort.