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Berrywood Ward - Improving access to psychological therapies

Berrywood Ward - Improving access to psychological therapies 

Berrywood ward layout Sept 2018.jpg

A project to improve the access to psychological therapy services for inpatients on Berrywood, an Older People's Mental Health ward at Western Community Hospital in Southampton.

"We aim to improve the access to psychological therapies for patients, by achieving more appointments for new patients and treatments started, a reduction in waiting times for appointments and more input for appropriate patients on the ward."

One of the key drivers for this project was to make improvements to the environment and culture so that patients were less likely to see a decline in their mental health, by enabling better social interaction on the ward and giving staff more time for therapeutic contact. Staff would also be supported to spot early indicators and access therapies for patients when needed.

Some quick and simple changes to the ward layout have already had a positive impact and made it a more pleasant environment, for patients to relax together and for staff to carry out observations in a less formal setting.

The project started off well and achieved many of the projected actions in the first 30 days. This included the main actions of appointing a new team administrator, advertising for a clinical psychologist and changing the ward environment to be more therapeutic.

Unfortunately as we moved towards the 60 day milestone there were unforeseen events which impacted on the ability of the team to continue to move on with their actions. The sister ward (Beaulieu) was shut down at only a week’s notice due to staffing issues and required a great deal of time and attention from the management team and staff. Very sadly, just as things were settling down after this upheaval, one of the team's psychiatry consultants died unexpectedly, which had a devastating impact on the team. 

We therefore decided to freeze the project for six weeks, to allow the team to regroup, maintain the changes already made, and come to terms with the changes in their service. The project group met at the start of January and agreed to restart the process with a view to taking a further 30 days to work on the project. We have agreed a plan for the next steps and will carry out repeat observations to look at changes so far in the amount of psychological thinking in clinical care plans and face to face patient time, which were the areas highlighted in the original observations to work on. 

Some quick and simple changes to the ward layout have already had a positive impact and made it a more pleasant environment, for patients to relax together and for staff to carry out observations in a less formal setting.

Outcomes

  • Increased the number of care plans with a psychological basis - from 16% to 83%
  • Increased trained nurse/patient time in the lounge from 1 minute to 6 minutes an hour – the quality of interactions witnessed was also more engaged and supportive than previously
  • OTs report more patient engagement in activity sessions, and are providing a more frequent structured activity programme, working alongside the coordinators
  • More positive patient/HCSW interactions in the patient lounge
  • More patient/patient positive interactions
  • Reduced the number of admin jobs being done by trained nursing staff
  • More discussion of psychological therapies on the ward
  • Change in dining room to encourage autonomy and prepare for discharge by fostering independence
  • Visitors allowed into patient lounge – more normalisation of activities of daily loving
  • Psychologist employed and has started this week
  • Training for staff planned and discussed for listening and validation

                   

Workstreams from the workshop:


 

1. ward environment – change of spaces to improve therapy time

2. administrator – full time admin job was already advertised, but this role was used to free nursing time

3. communication between inpatient and outpatient teams – matrons meeting, mindfulness sessions, shared admin meetings

4. training of staff in reflective practice, action learning sets, listening and validation training

5- design of job role for new clinical psychologist on the ward – advertised and recruited to

 

  • Active learning sets for reflective practice
  • Regular matrons meetings across inpatient and CMHT settings
  • Listening and validation teaching
  • Clinical supervision by clinical psychologist
  • Use of comprehend, cope and connect psychological formulation

 

       
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