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

Pod

Data C&H AOS Physical Monitoring 100% 90% 80% Percentage of Total Patients Monitored 70% 60% 50% 40% 30% 20% 10% 0% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 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%

Comparison of Physical Health Monitoring between AOS and Forensic AOS in April 2015 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% BP Weight BT ECG AOS Forensic AOS

Results of C&H AOS Physical Health Monitoring - Mid-May 2015 Abnormal ECG 15% Hyperlipidemia 28% Diabetic 24% Hypertension 20% Overweight 74% Smoker 71% 0% 10% 20% 30% 40% 50% 60% 70% 80%

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.