Improving physical health and well-being in mental health and learning disabilities patients in Oxleas

Mariam Aligawesa, Physical Health & Well-Being Practice Improvement Facilitator at Oxleas NHS Foundation Trust, led a project designed to improve physical health and well-being in patients with mental health problems and learning disabilities

Background

In November 2014 following incidents across the Trust as well as feedback from staff and service users there was clear need to prioritise physical health and well-being in mental health and learning disabilities patients.  A project was set up to implement this, led by the deteriorating patient working group, which has representation of staff from across the organisation.

Good Practice

The project has enabled good practice to be embedded and the sharing of learning through staff engagement at trust-wide conferences focusing on the whole person. These sessions have brought staff from across the trust together to share their practices and have raised the profile of physical health and wellbeing in Oxleas. Bi-annual Trust wide events are now held focusing on improving physical health with more frequent events within the directorates. Since August 2015 physical health and wellbeing has become part of the rolling trust-wide induction programme for junior doctors and further medical engagement has been undertaken through doctors away days and medical education board meetings. This has been instrumental in improving physical health monitoring for service users.

Physical health and well-being clinics for clients have been set up in 5 bedded mental health units, including Green parks house wards and Woodlands site, with a further 9 in community mental health services in Early Interventions Teams, Learning Disability and Children and Adolescent services across the trust.

Several initiatives for patients have been set up including:

  • A monthly health and well-being programme at Oxleas house site, set up in 2015, which includes smoking cessation and sexual health and is now embedded into the wards day to day practices.
  • The adult mental health and learning disability services and older people’s mental health services adapted the forensic smoking cessation programmes in reducing cardiometabolic risk factors from smoking and in preparation for going smoke free.
  • Green Parks House set up monthly smoking cessation clinics since April 2015 to support service users in promoting health and well-being.

Integration with Long Term Conditions: Bromley Healthcare scoped local services which enabled the creation of the physical health care and long term conditions care pathway directory leading to better access to specialist services for service users with mental health and learning disabilities in Bromley. Collaborative working with specialists and long term conditions services has led to the creation of resource packs including flow charts to prompt and guide clinical practice assessments and intervention for wound care with the embedded learning nurse (Juliet Blenman). Work is ongoing with diabetes and Cardiac specialists’ services.  Close working with the wound care embedded learning nurse has led to a reduction in pressure ulcer incidents in older people’s mental health services.

Some of the other outcomes of this project so far include:

  • The development of a new policy ‘Promoting the physical health and Wellbeing of service users with Mental Health and Learning disabilities’ outlining the roles and responsibilities of all staff across the organisation, to support improvements in the delivery of health care for service users
  • The production of a service user and carers guide to physical health well- being at home and in hospital which includes service user artwork from the Bracton Centre. An easy read version in currently in development with and for service users with learning disabilities, memory problems and for children and young people.
  • The Trust MEWS (Modified Early Warning Scores) chart was redesigned as a result of analysing incidents via this project. MEWS is a tool for assessing and managing deterioration of patients and monitoring long term conditions.  The new chart now includes blood glucose monitoring, weight monitoring, food and fluid monitoring and sepsis alert. Training on how to use the new chart has been rolled-out to staff.

The Institute of Integrated Care recently funded a project to look evaluate the effectiveness of this initiative.