Transcript Care Adjustments in Hospital: Better Care Healthier Lives

Things you must know about me
This is my
Name:
Hospital Passport
My Photo
Likes to be known as:
NHS number:
For people with learning disabilities coming into hospital
Date of Birth:
My name is:
I like to be called:
Address:
If I have to go to hospital this book needs to
go with me, it gives hospital staff important
information about me.
Tel No:
It needs to hang on the end of my bed and a
copy should be put in my notes.
How I communicate – e.g. What language I speak / Equipment / Signs / Photos / Symbols I use:
This passport belongs to me. Please return it when I am discharged.
Nursing and medical staff please look at my passport
before you do any interventions with me.
Family contact person, carer or other support:
Relationship e.g. Mum, Dad, Home Manager, Support Worker:
Things you must know about me
Address:
Things that are important to me
Tel No:
My support needs and who gives me the most support:
My likes and dislikes
Mental Capacity Act 2005
My carer speaks:
If I am assessed as lacking the capacity to consent to my treatment the following people must be involved in
best interest’s decision making
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Date completed
by
Care Adjustments in Hospital:
Better Care Healthier Lives for People
with Intellectual Disabilities.
Jim Blair
[email protected]
www.gosh.nhs.uk/intellectual-learning-disability
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Hospitals can be scary places..
The focus will be on:
• Practical solutions to challenging
problems
• Thinking differently acting creatively
• Alert flagging systems
• Reasonable adjustments – core and
bespoke- how they improve care
• Collaborative partnerships
The focus will be on:
• Link Leads for ID within hospital and
community across divisions and
disciplines
• Engaging Experts by Lived
Experience
• Education and training
• Supervision of staff
• Making LD Nursing in hospital a
success
It’s
MY life
About 25 people with learning disabilities die
each week from causes of death wholly or
partly amenable to good quality healthcare.
3 people each day
Professors Glover and Emerson of the Improving Health and Lives Learning Disabilities Observatory Using
data drawn from the Confidential Inquiry
My Role
Together we can get it right
• Specialist advice for people with learning
disability who may also have autism
• Assist with complex decisions
• Assessment of capacity
• Make reasonable adjustments
• Expert guidance
• Manage difficult situations
• Second opinion
• Build on existing work
My Role
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Provide 2nd Opinion
Lead on aspects of care
Challenge poor practice in real time
Education in action
Band 6 or 7 liaison post - seek to influence
change in practice by asking for RAs, tests,
investigations, modeling good practice
• Consultant level – request and expect = a
decision maker
Everybody’s Life Has Worth
• Beware of missing serious illness
• Find the best way to
communicate
• Make reasonable adjustments
• Rely more on visual information
• Give more time for processing
Practical Solutions to
Challenging Problems
Learning Disability Alerts Over 850 on system
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Prepare for a person coming in
Make care adjustments
Monitor outcomes and experiences
Improve care
Reasonable Adjustments
Things you must know about me
This is my
Name:
Hospital Passport
My Photo
For people with learning disabilities coming into hospital
My name is:
I like to be called:
Likes to be known as:
NHS number:
Date of Birth:
Address:
If I have to go to hospital this book needs to
go with me, it gives hospital staff important
information about me.
Tel No:
It needs to hang on the end of my bed and a
copy should be put in my notes.
How I communicate – e.g. What language I speak / Equipment / Signs / Photos / Symbols I use:
This passport belongs to me. Please return it when I am discharged.
Nursing and medical staff please look at my passport
before you do any interventions with me.
Family contact person, carer or other support:
Relationship e.g. Mum, Dad, Home Manager, Support Worker:
Things you must know about me
Address:
Things that are important to me
Tel No:
My likes and dislikes
My support needs and who gives me the most support:
Mental Capacity Act 2005
If I am assessed as lacking the capacity to consent to my treatment the following people must be involved in
best interest’s decision making
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Name
Relationship
Contact Details
My carer speaks:
Date completed
by
1
How the passport changes care
• Filled in by people with learning disabilities and
their supporter’s
• Provides a complete view of the person
• Not just about ill health
• Owned by the individual
• Personalises and dignifies care
• Enhances patient safety by providing information
about a person who may not otherwise be able
to tell health professionals
Adjusting Care -Think Differently
ACT Creatively
• Double appointments
• Environmental changes e.g. dimmer switches,
videos
• Clinics on Saturdays
• Learning disability specific clinics
• Health checks and patient held records
• Flexible appointment times
• No fixed visiting times
• Minimising waiting
• Increasing support for the person
A picture can say more than words
Books Beyond Words- helping people understand what is happening in their
health and in their lives www.booksbeyondwords.co.uk
Enhancing care and experiences
This is my
Hospital Passport
My Photo
For people with learning disabilities coming into hospital
My name is:
I like to be called:
If I have to go to hospital this book needs to
go with me, it gives hospital staff important
information about me.
It needs to hang on the end of my bed and a
copy should be put in my notes.
This passport belongs to me. Please return it when I am discharged.
Nursing and medical staff please look at my passport
before you do any interventions with me.
Things you must know about me
Things that are important to me
My likes and dislikes
Mental Capacity Act 2005
If I am assessed as lacking the capacity to consent to my treatment the following people must be involved in
best interest’s decision making
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Name
Relationship
Contact Details
Learning Disability Link Leads
within the Community and
Hospital
LD Link Leads –across the
hospital and community
• Rolling out of learning disability initiatives
across the services
• Monitoring, evaluating and changing
services through reasonable adjustments
• Providing colleagues with updates
• Assisting in prevention, admission and
discharge to reduce re admissions
Engaging Experts by Lived
Experience
Experts by Lived Experiences
• Engage people with LD and
families in service design,
accreditation, delivery,
evaluation, evolution and staff
training
• THEN we will get it the culture
and care right
Being involved –Experts by lived experience
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Be on Committees
Improve accessible information
Educate and train staff
Plan, develop and evaluate service
developments and changes
• Be involved in research that leads
to practical solutions / change
Collaborative Partnerships
Partnerships - Making an impact
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Other organisations across sectors
Trial and share information
Shaping practice together
Creating models that work
Being flexible less protective of ideas /
concepts
• INNOVATION – BE CREATIVE
Education
• In action in real time
• Specific issues faced by people with
learning disabilities and their families
• Reasonable adjustments
• Diagnostic Overshadowing
• Assessing a person’s understanding and
capacity to consent to treatment
• Communicating without words
• Post qualifying courses
From here to where?
Making Learning Disability
Nursing a success in Hospital
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Pre reg and post reg training
Clear vision and plan
Achievable outcomes
Community and hospital buy in
Clinical supervision
Voice on the Board
Commitment from commissioners
Core principles underpinning Intellectual
(Learning) Disability work
The following forms the foundation of the way Great Ormond Street Hospital delivers care to
and with people with learning disabilities and their families.
1. Value driven - children / young adults can contribute to their care
2. Positive communication - increase the use of positive terminology and place an
emphasis on appropriate communication
3. Appreciate the interaction - between the individual and their environment.
Understand the child's life experiences and how they express themselves
4. Increase independence - while acknowledging the stage or age of a child it is
important to focus on developing the child or young person's independence
5. Promote emotional literacy - ensure that children and young people have
opportunities to express themselves and help and support them to understand their own
feelings
6. Create a positive environment - welcoming setting - it is important to acknowledge
each child's individuality, culture and life experience so that they are valued and important
members of the hospital community
7. Focus on individual support - each person is an individual and will respond to
positively being addressed by their name and if the service takes into account their needs
rather than merely those of a group
8. Work towards achievable goals -
set goals that motivate and are achievable within
a timescale that is reasonable for that child and or for the service they are using
For more information and advice www.gosh.nhs.uk/intellectual-learning-disability
The Learning Disability Protocol for Preparation for
Theatre and Recovery
• Discuss the patient's needs with them and their family/carers.
• Use ‘comforters’ to relax the patient pre op and in recovery .
• Document and handover to colleagues.
Recover
patients with learning
disabilities slower
than those without one
a) Lower levels of noise and light
b) Place the patient in a quiet area within recovery
c) Ensure parents/carers are present and involved.
d) Gradually recover observing how the patient is progressing
If the patient is disturbed or distressed in Recovery:
1. Call an anaesthetist to use sedation to induce a relaxed, sleepier state.
2. Increase levels of sedation as required.
For more information and advice
www.gosh.nhs.uk/intellectual-learning-disability
Influencing change Making an impact
• LD Alerts
• Education in action
• Audits How many people on your ward have a learning disability?
• Leadership in decision making / clinical practice
• Networks in service and beyond
• Conferences – Good Practice Events
• Think differently beyond learning disabilities
• Engage staff to create own care
adjustments in their settings
• “It is no use saying, ‘We are
doing our best’
You have
got to succeed in doing
what is necessary.”
• Winston Churchill
Online accessible health information
for people with autism and or learning disabilities