Shared learning database

Alpha Hospital
Published date:
March 2011

The Self Injury and Suicide committee at Alpha Hospitals Bury Is a dedicated committee that works on improving and implementing evidence based practice across the hospital. The committee consists of a variety of experienced practitioners who work with individuals who self injure and service users who have personal experience of self injury. The committee meet once a month to plan initiatives that are carried out throughout the month. The committee works to a partnership/collaborative model and the service users are valued members of the committee whose input is greatly valued alongside that of the experienced practitioners.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The committee set a task to increase staff awareness, training and interpersonal skills to work with individuals who self injure. The work was split into 6 categories to provide an over arching evidence based approach to improve recovery outcomes and quality of experience for service users. The categories were defined as:- 1) Service user involvement in the committee. 2) Qualitative data to measure reduction of self injury, and to improve practice. 3) Guidance for enabling practitioners- a partnership approach between service users and practitioners. 4) Service user led training programme. 5) Review of the impact on reduction of self injury, and improvement of knowledge and practice of practitioners. 6) Posters, flow charts and information on wound care management. The overall aim of the initiative was to enhance the service user's road to recovery and to improve their interpersonal experiences with practitioners as evidenced through Centre of Mental Health, Implementing Recovery a New Frame Work for Organisational Change. Making Recovery a Reality 2008 (1) (2) and Royal College of Psychiatrists College Report CR158, Self harm, suicide and Risk: helping people who self harm 2010 (3). Whilst lending itself to better therapeutic alliances between service users and practitioners Motz,A 2009.(4), validating the recovery principles and reducing the negative associations to self injury NICE CG16 2010 (5). The development of a collaborative committee ensured that the service user's knowledge, skills and experiences sat alongside that of experienced practitioners. By using this approach the committee was able to produce a development strategy/action plan to tackle the deficits in practice expressed by service users and practitioners alike. The objectives were set out to provide the definition of the strategy/action plan following the qualitative questionnaire data. To provide quality enhanced care provision for women who self injure in medium and low secure services, based on the principles of recovery and quality outcome measures. Improvements in practitioners approach to working with individuals who self injure, promoting the avenues of a quality service user/practitioner alliance and engagement. Enabling service users to access a high standard of quality care focused on the individual. Increasing service user's contribution to service delivery, policy, procedure and standards through partnership working. Putting the service users at the heart of development strategies from the planning through to evaluation, ensuring their contribution is valued equally alongside the experienced practitioners. To meet the training and education needs of the practitioners working in women secure services given the specialist nature of the services Jeffcote,N. Watson, T. 2006(5).

Reasons for implementing your project

In September 2008 the self injury and suicide committee at Alpha Hospitals Bury was reconfigured to ensure that experienced practitioners and those with an interest in working on developments in this area was given opportunities to become involved in the group. Through canvassing for interest it became apparent that both service users and practitioners felt there could be more done in terms of increasing the understanding and knowledge base of the practitioners working in the women's services. This was to become the first agenda item for the newly reformed committee. The committee began to develop a strategy to target avenues of practice improvement for practitioners working and supporting individuals who self injure. A practitioner questionnaire was developed to gain information from practitioners working in the women's service. The questionnaire requested information from the practitioners in terms of current understanding, knowledge base and experiences. It also asked the question - what further training, knowledge base and experiences would enhance your skills and practice? The questionnaire was delivered by the Assistant Practitioner who presented the questionnaire in a 1:1 semi structured interview. This method was chosen given previous experiences where the return of questionnaires was minimal and did not provide good qualitative data. On receipt of the questionnaires the information was analysed and key themes were noted and selected to inform the development strategy.

How did you implement the project

1. Service user involvement in the self injury and suicide committee. Women were asked if they would be interested in joining the self injury and suicide committee. One woman was welcomed to the committee. There have been no costs incurred in this intervention. 2. The Qualitative data was collected in the form of a questionnaire. The same questionnaire was used to provide a base line at the evaluation stage to evidence improvement impact. Cost incurred, 3 days of assistant practitioners/data analysis time. 3. The guidance booklet was completed by both service users, committee members. Service users commented on improvements in the relationships between themselves and the practitioners. Costs incurred for this project. Practitioner time, service user time and publication costs. 4. The service user led training programme was split into 2 parts. A life story presentation on power point (I Will Survive) and awareness sessions (SLASH -Start Learning about Self Harm). Costing for this initiative was incurred by practitioners and service user time. This was minimised due to utilising practitioner time through the induction process. 5. The reviewing process was integrated into the monthly committee meeting as a set agenda item. 6. Posters, flow charts and information on wound care management. The committee approached this in a variety of ways. A flow chart was devised using evidence based information. Wound care information leaflets were developed by the practice nurse to guide individuals on best care examples for different wounds. Information on how to assess for infection and appropriate treatments. The practice nurse holds interactive demonstration sessions for service users and practitioners. The practice nurse links closely to the infection prevention committee, the GP and the local A+E department.

Key findings

On the implementation of the above interventions a follow up questionnaire was completed to determine if there had been an improvement in outcomes. The data collected was very positive indicating that the practitioners had a better understanding and knowledge base of self injury. Data was also collated from the reporting of incidents of self injury between Sept 2008-2009 and Sept 2009-2010 . A comparison of the data between these two years showed a reduction of self injury across the service by 7% in the year September 2009 and 2010. Service users have moved positively through their recovery and care pathway. There has been a greater alliance between the service users and practitioners. There is a noted openness towards self injury and positive interventions are used widely.

Key learning points

These initiatives could have only provided a positive impact by the full integration of service users into the committee and the service as a whole. Key learning points were identified as:- - The use of data enabled the committee to develop the strategy and to evaluate quality impact. - The development strategy provided an excellent tool for ensuring identified areas were addressed. - The willingness and the acceptance of the service users by the practitioners. There had to be work done in terms of promotion of recovery principles and changes made to the culture of the service. - Practitioners needed to be aware of service users' confidence and capabilities. The committee members needed to provide the service users with time, education and skills to be able to be comfortable sitting on the committee with the practitioners, to be able to complete task as directed by the committee or as requested by other service users and ongoing support whilst delivering the SLASH training sessions. - Practitioners needed to be mindful of services users' mental health and provide more time or support if the service user is having a difficult time or experiencing a relapse, working with the individual at their own pace and allowing for expansions of time frames. - Supervision support was crucial for the service user the same as it is identified for practitioners.

Contact details

Colleen Fahy
Nurse Consultant
Alpha Hospital

Is the example industry-sponsored in any way?