High Quality Patient Care and Treatment
In this section:
- Care and Treatment Planning
- Attendance by Clinical Staff at Case Reviews
- Medicines Management
- Psychological Therapies Service (PTS)
- Rehabilitation Therapies
Treatment planning processes within the Hospital are well established. There is a co-ordinated approach to annual and intermediate re
views, the Care Programme Approach (CPA), clinical risk assessments, Integrated Care Pathways (ICPs), and to ensuring that the Hospital meets national guidance and legislation relating to treatment planning and discharge processes.
Within a safe and secure setting, expert and high quality, care and treatment is delivered by multi-disciplinary teams comprising psychiatry, nursing, occupational therapy, pharmacy, psychology, activity and recreation, social work and security.
Key Performance Indicator (KPI)
Patients have their care and treatment plans reviewed at six monthly intervals.
Performance improved in 2018/19 with 96.9% of patients having their care and treatment plans reviewed at six monthly intervals compared to 95.4% achieved in 2017/18. The target is 100%.
Key Performance Indicator (KPI)
Patients will have their clinical risk assessment reviewed annually.
At 99% in both 2017/18 and 2018/19, performance was only slightly below the 100% target.
Attendance by Clinical Staff at Case Reviews
In addition to multi-disciplinary clinical teams all patients are assigned a Key Worker on admission to the Hospital. The Key Worker is an experienced Registered Nurse who, in collaboration with the patient, is responsible for the assessment, planning, implementation and evaluation of the day to day care of the patient. As the identified practitioner for a small group of patients, the Key Worker will develop a positive, caring, and therapeutic relationship over time with each of their patients and their family or carers. The Key Worker is supported by an Associate Worker.
Pharmacy services continue to be provided from NHS Lothian which includes medicine supply from St John’s Hospital, Livingston plus a specialist onsite Clinical Pharmacy service.
The Hospital’s Medicines Committee is well established. Workstreams focus on medicines management, the safe use of medicines, clinical effectiveness, and patient safety. Over the last 12 months, 59 guidelines / standards were reviewed by the Medicines Committee. Of these, 54 were deemed to be either not relevant or were covered by a similar guideline. The remaining five guidelines / standards had varying degrees of relevancy to medication services within The State Hospital and were sent out for information purposes.
Key pieces of work through Pharmacy and the Medicines Committee in 2018/19 included:
- Introduction of a pharmacist prescriber to support the review of chronic physical health conditions as part of the Health Centre team.
- Formation of a specific Medication Incident Review Group for more robust learning from medication incidents.
- EU Exit resilience planning around medicine supplies.
- Preparing to comply with falsified ‘fake’ medicine regulation checks.
- Extensive clinical audit programme of work – both national and local.
- Policy and guidance updates, including use of intramuscular medication, high dose antipsychotic monitoring, and access to non-approved medicines.
An exciting development that has also been explored in 2018/19 in collaboration with NHS Lothian, is the opportunity for development of electronic prescribing within the Hospital in line with Scottish Government eHealth Strategy. Work will continue into 2019/20.
Psychological Therapies Service (PTS)
Within The State Hospital psychological interventions are designed around the underlying needs of the patients rather than their diagnosis or problems. Psychological interventions take place both on and off the ward, in groups and on a 1:1 basis. Some psychological interventions have specially adapted versions for patients with intellectual disabilities or specific cognitive deficits (for example, acquired brain injury).
In 2018/19, on average 94% of patients were engaged in psychological interventions at any one time over the year, with no patients waiting longer than 18 weeks for an intervention.
The Psychological Therapies Service delivered 12 presentations at national conferences during the year including:
- A case study of complex trauma and its effects on personality development.
- Neuropsychological differences between violent and non-violent offenders: A Systematic Review and Meta-Analysis. Conference presentation: British Psychological Society Division of Forensic Psychology Conference, Newcastle, UK
- MBT-informed structured clinical care – a case study. Conference presentation. Forensic Lead Nurse Conference, SPSC Polmont, UK.
Additionally, numerous research studies were ongoing and published in peer reviewed journals. For example:
- Cognitive Behavioural Therapy (CBT) for psychosis and personality disorder in a high secure forensic setting: An evaluation of the impact of an integrated treatment programme using a mixed method design.
- An exploration into how forensic mental health nurses predict and cope with violence and aggression in a high-security setting.
- An investigation into behavioural stability in forensic mental health units - a comparison of the predictive validity of instruments to identify violence risk.
- Mirror, mirror on the ward... are our reflective practice groups effectively supporting nurses to do their ‘BEST’? Childhood psychopathic traits, Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) among twins – what does maltreatment add to the equation?
Quality improvement projects are being developed to enhance the efficiency of group delivery and improve the quality and consistency of assessment and formulation.
A Psychological Therapies Service 12 month update report is produced annually covering the period January to December.
Key Performance Indicator (KPI)
Patients will be engaged in psychological therapies.
Performance over the course of the year was consistently above target with 92.8% of patients being engaged in psychological treatment compared to a target of 85%. The 2017/18 figure was 94.4%.
All but one patient commenced psychological therapies in less than 18 weeks from referral date in 2018/19.
State Hospital Fact Sheet - 'Psychological Therapies' (October 2016)
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The Skye Centre has four patient activity centres and an Atrium area which consists of a cafe, library, bank and shop – all of which patients use on a regular basis.
There are also a variety of other groups facilitated in this environment including the Patient Partnership Group (PPG), Christian Fellowship, Multi-faith services, Psychological Therapy groups, Allied Health Professions group and individual sessions.
At the end of March 2019, 89 patients (84%) were attending placements in the Skye Centre.
The patient shop was audited against the Healthcare Retail Standard in March 2019 with positive results; 100% compliance in drink products and 84% compliance in food products.
The following are key pieces of work undertaken from 1 April 2018 to 31 March 2019:
- Redesign of the Woodwork Centre.
- Arts Therapies review.
- Patient Active Day project.
- Review and update of Patient Menus following feedback from patients.
- Activity scheduling – patient timetable on RIO.
- Development of Skye Centre induction for new admissions.
- Implementation of ONELAN information system (digital visual communication technology).
Key Performance Indicator (KPI)
Patients will be engaged in off-hub activities.
This indicator has seen an improvement from 78.7% in 2017/18 to 81.7% in 2018/19 against a 90% target.