Shared learning database

 
Organisation:
Royal Berkshire Hospital NHS Foundation Trust
Published date:
May 2019

Using NICE guidance: Improving Supportive and Palliative Care for Adults with Cancer. We identified that we needed to: 'maximise patients’ ability to function, to promote their independence and to help them to adapt to their condition' as well as encouraging patients to play a central role in their own rehabilitation and take an active role through self-management.

We developed a peer support and information group targeting self-management skills both to prepare for discharge and maintain health and well-being at home.

This could be rolled out to outpatient services to meet many more NICE guidelines.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
No
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Yes

Example

Aims and objectives

Looking to:

Reduce patients' stress and anxiety

Improve confidence around patients' discharge and their ongoing self-management

Shorten patients' length of stay on acute ward

Add value to days in hospital awaiting scans, surgery or the outcome of a treatment review meeting (MDT case review)

Provide strategies and support services to prevent re-admission

Achieve an overall improvement with satisfaction with cancer services within Berkshire 


Reasons for implementing your project

This project was implemented on a 16 bed ward - acute inpatient oncology within a large general hospital

In a review of the NHS England Cancer strategy and NICE guidelines for cancer it was identified that there was a need to provide support information on self-management techniques.

Therapists found they had difficulty in engaging patients in sessions with physiotherapy and occupational therapy due to anxiety, depression and the lack of a change of scenery (we would routinely ask patients to sit in a chair next to the bed to practice transfers).

Difficulty in engaging patient in conversations about discharge planning.

Patient and families reported distress at symptoms of cancer and side effects of treatments, as a result they often have high levels of anxiety about how they will manage at home.

We collected data about:

How many times patients refused Occupational Therapy and Physio treatment sessions.

Engaged Staff members and patients about what they want from their therapists through a survey.

We identified that the cost of running a group once a fortnight for 1 hour was approximately half the cost of a therapist completing one to one sessions.

The time saving also allows the therapy team to provide more interventions within the same amount of time as there was no scope to increase working hours.


How did you implement the project

Researched NICE guidelines

Looked at evidence-based interventions 

Visit and investigate other agencies offering similar services

Initial meeting with oncology team including; Palliative Care Therapists, Ward sister, Matron, Clinical Lead Consultant, Occupational Therapists, Physiotherapists.

A questionnaire was developed for patients and staff to contribute ideas

Analysis from questionnaire results lead to development of group programme.

We sought funding from league of friends for aromatherapy supplies

Ward therapist was able to change the way in which she worked by compiling the group to see more patients in the same amount of time.

Agreement was sought from managerial staff to cover this service during annual leave and sickness as well as an assistant to provide operational support.


Key findings

This project is ongoing so we do not yet currently have sufficient data to display results.

We are collecting data about:

Length of stay

Amount of meaningful days in hospital

Patient's nursing equity

Barthel scale. The Barthel scale is an ordinal scale used to measure performance in activities of daily living (ADL). Each performance item is rated on this scale with a given number of points assigned to each level or ranking./ FIMThe Functional Independence Measure (FIM) is an 18-item of physical, psychological and social function. The tool is used to assess a patient's level of disability as well as change in patient status in response to rehabilitation or medical intervention

Mood - Hospital Anxiety and Depression Score

Level of confidence about use of self-management techniques before and after sessions.

The projected cost saving is:  £1567.84 per year

The aim being to see 78 more patients per year

Long term results may lead to reduced numbers of readmissions though projecting admission avoidance savings would be difficult.


Key learning points

Increase the number of meetings with stakeholders throughout the process to maintain pace and progress.

It was difficult to focus in on just a few key issues as there are so many possibilities to improve patient care in this area. Utilising questionnaires helped to determine the greatest area of need first and then point to further areas to explore.

Listening and acknowledging needs that could not be met by this project.

Link in with other initiatives already in place within the area it is implemented.

 


Contact details

Name:
Laura Hughes/Elena Fernandez
Job:
Highly Specialist Occupational Therapist
Organisation:
Royal Berkshire Hospital NHS Foundation Trust
Email:
Laura.hughes@royalberkshire.nhs.uk

Sector:
Primary care
Is the example industry-sponsored in any way?
Yes

Macmillan and league of friends funding - aromatherapy supplies