1.

SIP (Service Improvement Project) 3 Interim Progress Proforma Intervention-led SIP

Please detail a brief project plan here To create an instruction / guidance folder for systems within an out of hours Emergency Duty Team. Email team members to inform them of project and to request feedback of any areas with which they are having difficulties so these can be included in the instruction folder. I will write up and produce laminated instruction sheets which will act as guides for staff to assist with their performance of duties within a busy out of hours social services team. In order to keep this project manageable and small I will begin by introducing approx. 10 sheets for various systems. The project will be Intervention Led as the need has already been identified. The email to staff will assist with the creation of the instruction folder. Once in place I will give staff one month to trial the folders The evaluation will take place via focus group to discuss how useful the intervention has been and to identify future needs for expanding the folder. Please detail the extent of your progress here I have emailed staff to advise re plan for Instruction Folder and request any further feedback. I am working with management re implementation of intervention I am in process of designing instruction sheets

Research question/s: Please detail the question/s your research will answer here Has the provision of an Instructions Folder improved confidence levels of staff in the performance of their role within an Emergency Duty Team? Has the Instructions Folder improved consistency of practice within the team?

Progress on Research input: Please detail your progress in evaluating the intervention here I have received a positive response to my email advising colleagues of my planned intervention Staff are in agreement re need for an Instructions Folder and have offered ideas for input to the folder.

General comments: Please place any issues or concerns here The Team are going through a difficult time at present with many staff changes, no permanent Team Manager and current staff under much pressure covering extra shifts and working overtime. Due to working three times my usual hours I have less time to devote to study than anticipated so have fallen behind. I had hoped to trial intervention with new and old staff however new staff will not be in place till mid to end of April.

2. SIP 3 Interim Progress proforma

Enquiry-led SIP
Project plan: March: prepare for and seek permission from County Council and NHS Trust for completion of focus groups and semi-structured interviews. Have completed: Focus group structure Semi-structured interview questions Information forms Consent forms.

I have discussed the focus groups in our team meeting. I have also emailed the team, requesting they keep a provisional date free. Unfortunately this is not until the 1st May, as I will not have approval from the County prior to the Easter school holidays, when lots of staff members will be off. However, I am aiming to complete the interviews during this period. April: May: June: July: Simple evaluation of change to process to be completed via email by 5/07/14. Write up to be completed and hand in by 28/07/14. Steps to address problem to have been implemented by 6/06/14. Write up to begin. Complete focus groups on the 1/05/14. Complete thematic analysis. Take steps towards addressing identified problem. Distribute information sheets and obtain consent from all participants. Complete Semi-structured interviews.

Research question/s:

What are the challenges and/or difficulties you have when following these procedures? What do you think would improve this for you?

Progress on Research input: As above. Disappointing that I am not able to complete the focus groups earlier, but this is due to school holidays followed by my own annual leave, which is taking up a significant chunk of April. Progress on intervention: N/A as focus groups/interviews have not been completed yet, cannot expand any more than plan above. General comments: Still hoping that Im on track! Due to the school holidays being in April, I think May will be fairly busy. But I still feel that in keeping the project small and focused, I will be able to implement the change and evaluate within the above time frame.

3. SIP 3 interim Progress Proforma

Enquiry-led SIP
Project plan: The aim of the service improvement project is to improve the rate of compliance with the MCA amongst care coordinators. Research question/s: Section 2 of the PSIP attempts to define a question which will be directly related to the project aim. I settled on the following question; How closely do mental health workers in an Older Adult Community Mental Health Team comply with the Mental Capacity Act?. Feedback from my tutors included the fact that the questions should focus on the key issues (or factors) involved in practitioners achieving close compliance with the MCA. This above question provides a close alignment with my focus group. That is, the questions presented to my colleagues will be more concerned with the factors they feel aid or inhibit their compliance with the MCA. This reflection has focused my thinking on what questions I might present to my colleagues in order to better understand what intervention might improve their compliance with the MCA.

Progress on Research input: Consent form, focus group interview guide and information sheet are all completed. The pilot group was held on 21/03/2014 and provided some very helpful learning points to consider when planning and facilitating my focus group. Housekeeping: Remembering to ask the participants to switch their phones off and ensure that they are not obstructing any cars in our car park (an ongoing problem on our site). Ethics of the participation of workers with line management relationships: Prospective participants feel that there would be a more candid exchange if their line managers were not present. The initial idea was for all care coordinators (including the lead social worker and lead occupational therapist) to be invited to participate. I will now negotiate the removal of these colleagues from the list of participants invited. Language: Dont use jargonistic language during the focus group; use language which is accessible to all. Sound quality: All participants could be clearly heard on the digital recording from a one and a half meter range. My humming in agreement with the statements of the participants seemed to interfere with the clarity of the sound. This would be an issue if I attempted to transcribe.

Progress on intervention: From preliminary indications from colleagues and my initial findings from my pilot group, I have begun to think about what form my intervention would take. General comments: Plan Full Focus group to be held on 4th April 2014, 10:00h. Intervention to be designed by mid April and implemented throughout May. Evaluation will be carried on in mid-June, with the majority of the analysis completed by then.

4. SIP 3 Interim Progress Proforma

Intervention-led SIP
Project plan: My SIP is intervention led because it is concerned with change management which is a well recognized and theorized discipline. My SIP focuses on transition, which is the term used to describe the process by which people adapt emotionally to new situations. I am applying this knowledge to my particular service change circumstance. I will be using an established change management tool, the Personal Transition Curve (PTC), to capture a snapshot of how my staff are feeling about the work place changes they are experiencing. The PTC self-assessments will then inform a response strategy which will also constitute my SIP intervention. After 3 months of exposure to this intervention staff will be asked to complete a repeat evaluation of their feelings about change and a comparison will be made with the original assessment results. This will enable me to assess the progress of staff towards adoption of the new service structures and to draw conclusions regarding the impact of my intervention. Progress on intervention: Following BU ethics approval; project information sheets, participant consent forms and the initial personal transition curve response sheets were distributed in November 2013. 19 curves were sent out and 16 were returned. The responses were mapped on to the companion curve in the NHS Change Management Navigating Change toolkit. The majority of the responses (9) fell in the third quadrant of the companion curve which indicates that regular and reliable information about what is happening during the change is required to enable the team to process and internalize the changes, feel involved and encouraged, and to move forward on the PTC. The remaining 6 respondents were further forward in their assimilation of the changes and required clear direction to enable them to establish themselves in their new environment. Overall both these objectives, namely provision of reliable information and provision of a clear direction, could be met by increasing the frequency of communication between me and my team. The nineteen members of my team are spread the length and breadth of Dorset. I felt that it was important that everybody got the same information at the same time. This meant that a face to face verbal communication strategy was impractical and that the medium for communication had to be email. Since 3rd January 2014 I have been writing a weekly newsletter which has covered 4 key areas of change in our service namely general non specific change, technological change, clinical change and management change. I have also added in an end of the month 15 min CPD section where I attach some articles which relate to an information strand which has been in the Newsletter previously. I hope that this draws attention up from the shop floor for a moment of respite whilst still being, in my view, relevant!

I recognise that I am only using this one vehicle for my communication intervention. This will be open to scrutiny in my SIP final evaluation.

Research question: Does the use of change management techniques help staff in the Community Adult Speech and Language Therapy Team cope with change?

Progress on Research input: I have yet to collect my second set of transition curve data so have done no analysis. I have noted that if I ask for information in response to content it is largely unsuccessful. I therefore am not sure whether this means that the newsletter is not read or that staff dont see the newsletter as an appropriate medium for two way communication! It may alternatively be that the items I include are not thought to be of interest or benefit. I choose the items because I consider them to be of value in setting context or explaining purpose and so contributing to the establishment of a common understanding of context. I do see that this is in my opinion only and it may be the wrong approach. These are issues to consider in the evaluation of the SIP.

General comments: I have also been keeping a reflective diary. The set of questions which I answer also come from the Navigating Change toolkit and provide a fixed framework within which I can capture my feelings and observations about what has been happening during each of my working days. This was a late in the day decision and not part of my original plan but I thought it would be interesting to capture my own progress through the SIP period as a counterpoint.

5. SIP 3 Interim Progress Proforma

Enquiry-led SIP Project plan: I plan to interview local faith group leaders to gather information relating to faith and dementia. It is hoped that these structured interviews will provide themes and issues which will inform better knowledge and working links on both sides between the local Community Mental Health Team (CMHT) and faith groups. I plan to digitally audio record the interviews and fully transcribe them.

Research question/s: I currently have not formulated a specific research question. However, my aim is to gather information with regard to faith and dementia locally, in order to improve knowledge and links between the CMHT and faith groups in both parties.

Progress on Research input: As I have not started interviewing people, I have not yet gathered this information. However, I feel that it is likely that some good work (from both CMHT and faith groups locally) is being already done. It is possible that some form of information exchange or training on either side may be of help to both parties.

Progress on intervention: As outlined above, I am yet to start the interview process. I have some questions for interview formulated and have contact details for local faith groups. At this point, I need to complete question formulation, get critical feedback on them and then commence with interviews. I would like to commence interviews early in April 2014 in order to complete (including the transcribing and coding of them) before the end of May 2014. This should provide a minimum of 2 months for evaluation of data, the intervention and final essay writing.

General comments:

I feel very motivated and interested in this study and am really looking forward to commencing interviews. I am aware that I need to be conscious of time, in order not to let things slip! My only other concern at present is to ensure I have clear aims and objectives. In addition to this, I may require some assistance to ensure my interview questions are robust, non-ambiguous and relevant to the information I want to gather.

6. SIP 3 Interim Progress Proforma Enquiry-led SIP lone working of AMHPs

Project plan: Please detail a brief project plan here Complete Participation Information Sheet and Informed Consent form Inform local research governance department of my intended activity Audit MH1s Data gathered from MH1s completed from June/Sept 2013 Feb 2014 (dependent on the amount of assessments undertaken looking for approximately 60). Analysing data that relates to risk incidents/near misses, timescales in completing assessments, ambulance delays, length of time lone working and demographic characteristics (gender, experience and the area each AMHP is working in). From information gathered above I will develop my research questionnaire and disseminate to AMHPs in the HTT, AOT and 2 x CMHTs Total approximately 12 along with Participation and consent forms via email. The questionnaire will be a mixture of closed and open questions to gain the best evidence of AMHPs experiences of lone working. Utilising exact responses to gain demographic data and a mixture of ordinal and semantic responses together with space for personal experiences to be recorded. This will provide me with information on the safety and risk management/assessment, systems/processes used by AMHPs in their practice. I intend to allow a timescale of 3-4 weeks for return of questionnaires. The gathering and analysis of risk management tools and procedures used out of county by AMHPs carrying out assessments. I intend to follow the process of the lone working policy and procedures within my own workplace to switchboard protocol, to evaluate whether this is being adhered to and how robust the policy is in relation to the safety and lone working of AMHPs. Evaluate all information gathered and begin write up of findings and implement proposed intervention. Evaluate implementation and include recommendations into research project assignment.

Research question/s: Please detail the question/s your research will answer/has answered here My research will highlight any problems experienced by AMHPs when lone working and will provide best practice used to overcome and manage the risk and safety issues experienced Progress on Research input: Please detail the extent of your progress in clearly defining the problem/issue and in the design of potential interventions here The identified problem of AMHPs lone working is the risk management once a MHAA is completed and the Doctors leave. The AMHP is left to coordinate conveyance and risk manage the patient and their family independently. Potential interventions include: A change in policy that indicates the care coordinator for the patient must be in attendance at MHAA, for their patients to provide support and risk management to patients, their families and AMHPs. This is a potentially very difficult and lengthy intervention to implement and ensure adherence. Ensure reading, understanding and adherence to Lone working policy and procedures both within the CMHT and Switchboard protocol after working hours, which would ensure AMHPs had support and advice available to them whilst lone working to enhance their safety within the community. The development of a risk management tool to be used to identify and manage risk whilst carrying out assessments. Analysis of evidence may highlight best practice that could be implemented to all teams via Senior Practitioners.

Progress on intervention: Please detail your plans for the intervention and its evaluation here I have no current plans for the intervention until I have gathered all the evidence which will identify the best course of action and the most suitable intervention.

To date I have:

Made contact with IT and awaiting MH1 information for analysis. Drafted a Participation Information Sheet and Informed Consent form Emailed AMHPs from out of county for risk management tools used within their practice

General comments: Please place any issues or concerns here Timescale in gathering all evidence required. Too much information to gather? Have I gone to big/wide? Could I get the answers I need to decide on the best intervention in a simpler way? Who do I need to contact regarding Ethics approval? Will the Head of social work for NHS trust suffice or do I need to contact the research data office for approval?

7. SIP 3 Interim Progress Proforma Enquiry-led study - Research Question (s) The question my research will aim to answer is whether an intervention, during the facilitation of the Hospital at Night system, during out of hour periods within an acute hospital trust, would be beneficial to increase patient care and safety. The research carried out would highlight appropriate interventions which would increase the amount of deteriorating patients seen by the clinical site nurse practitioner. It is clear from carrying out my psip that the intervention would not be a designable pathway or assessment sheet or a new way in which the Hospital at Night would be facilitated.

Progress on Research input. Approached the ethics committee and presented my proposed study and awaiting approval. Discussed with the audit department to assist with designing the online questionnaire and have a meeting with them to do this on March 28th 2014. I have been able to contact members of the clinical database to formulate facts and figures over a four month period on the following; Pre Intervention. Research criteria 1. Number of H@N calls that the CST have answered in relation to carrying basic nursing tasks such as venepuncture, cannulation, ECG recordings, female and male urinary catheterization. 2. Number of Amber and Red calls that the doctors have seen and compare the calls to which the CST could have answered if not requested to carryout basic nursing skills. 3. Number of Amber and Red calls on H@N that the CST has answered and what were the calls regarding. 4. Number of Adverse Incident Reports relating to delayed patient assessment or care delivery due to delayed responses from the H@N Doctor / CST. All the above I have obtained and am currently formulating an analysis of this data in excel. Proposed interventions which are apparent and those discussed with my line manager include: 1. Removing basic nursing task from H@N which would mean that the ownership and responsibility falls back on the ward nurses.Problem- this would cause patients to have further delays in treatment.

2. The facilitation of H@N will produce a name and shame to which senior nurses and clinical leaders have to justify why their staff are not being appropriately trained to care for their patients adequately. Problem: although this highlights breakdown in training and skill mix on a ward, the clinical leaders and senior nurses may add further stress upon the ward nurses which is unnecessary. 3. To employ a Health care assistant to be part of the H@N team in which they are already trained and competent to complete basic invasive nursing tasks. Problem: obtaining funding might be an issue due to current economic climate however from carrying out my psip all the research conducted on this topic highlighted how vital a HCA is to the H@N. Progress on Intervention; A trial is currently underway to ascertain the effectiveness of using a H@N HCA during a period from 17:00 hours to 02:00 hours. I will contact the clinical data base people to send me data highlighted above, by using the same criteria to ensure reliability and validity. I will also gain feedback from the CST to see if they feel that by having a HCA on the H@N team aids in increasing patients assessments. General Comments. I am concerned that I have not heard anything from RBH ethics committee and will be chasing this on 30th March 2014. I am having difficulty in designing the questionnaire but hopefully my meeting with the audit department will clear thing up.

Month Date December January February Obtain information regarding H@N Data 01.12.13 Pre intervention. 01.03.14 Start Consent Forms and 01.12.13 Info Sheets 01.02.14

Project Plan March April May June July Review date 18.02.14 Obtain Ethics Approval from RBH Complete Consent forms and Info Sheets Design Questionnaires Dw Audit department Re questionnaires Send out and collect questionnaires from both teams send appendix 2 by 25th March Obtain information regarding H@N Data Post Intervention. 17.03.14 + 15.04.14 28.03.14 01.04.14

01.03.14

20.04.14

01.04.14 21.02.14 01.05.14

01.06.14 20.03.14 01.07.14

start converting data into graphs, review data and questionnaire analysis and by May start writing SIP prepare to hand 01.01.14 in Other considerations

01.07.14

8. SIP 3 Interim Progress Proforma Enquiry-led SIP Project plan: February Contact Research Governance to explain that I am doing a project which is non-research based. DONE Design Consent Form and Information Form COMPLETED FOCUS GROUP TO TAKE PLACE ON 27th MARCH: Tap recorder ALL AMHPS have signed consent form Plan ready to take in Other examples are available NR policy March Plan focus Group questions Get a few designs that are already in place April Critically Evaluate themes from focus group See if you could have done anything else/different. 4-6th OFF FOR BIRTHDAY! May Implement Intervention June Send email to all AMHPs to gain feedback of intervention July Reference

Conclude and make recommendations

Identify Focus Group in March or VERY early April27th March 2014 Email the group once identified with consent forms etc- Emailed 1st March 2014. Contact H about plans and identify who can sign offMet with H and agreed RF will sign off.

20th-21st- STUDY DAYS- Meet PK at Bournemouth Uni Library.

Design Intervention and send to R to be looked through for feedback.

Third Person to read through Assignment

Transcribe Focus Group Must be clear Summarise what people have said Get third person to read and listen to summarise 18th-22ND HOLIDAY

Start ESSAY- get plan done and contents by end of month

Have draft essay completed.

Have final draft completed and handed in by 25th July 2014.

28th

Re-Read Literature Review

26-28TH WEDDING

HAND IN DATE!!!!

Research question/s: From completing my PSIP I have been able to see how other authorities have supported AMHPs when applying to court to appoint a nearest relative for a patient. This highlighted a variety of interventions currently in place which I am aware my authority do not have. There are a variety of questions that I want to pose to AMHPs within the Focus Group they include: Introductory Questions: 1. Has anyone looked or used the Appointing a Nearest Relative Policy? If so what did you think of it?

2. If you have identified that a patient had no nearest relative, how confident do you feel with what you need to do next and whos responsibility it is to follow this process through? 3. If you were asked to identify a nearest relative for a patient that you detained, how would you start this process? 4. If you identified that a patient had no nearest relative and had to apply to court how confident would you feel with this process? This includes: legal obligations and writing a report to the courts to appoint the local authority as NR. 5. Why do you think that we do not apply to courts on a regular basis? Key Questions 1. Now we have identified the above (clear the process is unclear and not supportive to AMHPs), within my PSIP I found a variet y of interventions/tools which support AMHPs within their role. Which ones do you feel are informative, supportive and clear? Examples given: How would you like the information given to you e.g. flowchart or diagram? 2. When I have designed the intervention what are the key facts you would like me to include? Example: If a patient has capacity where you should go BOP Solicitors name/details What we need to write in a court report?

3. Once I have designed the intervention how would you like me to present it? For example in another AMHP Forum with me providing an explanation or in an email with notes?

Progress on Research input: From my PSIP I have seen a variety of interventions that support AMHPs and their managers. They include flowcharts to assist AMHPs with a step by step guide from when they identify a patient has no nearest relative to what they have to write in a court report. These have been clear and precise and what I am wanting to use as examples in the focus group.

I have also contacted the Research Department within my local authority and they have approved my project. The AMHP Lead has recently left and he was due to sign my project off. I therefore have met with unit lead and approached my Team Leader who is happy to support me within my project. I have designed my Information and Consent Form. I have identified when I will be holding my Focus Group however I need to ensure I have the equipment ready.

Progress on intervention: Once I have completed the Focus Group I can start to design the intervention. This should be in April 2014 as the focus group is planned for the 27th March 2014. General comments: The only difficulty I have seen at present is the fact AMHPs are taking leave as it is the end of the financial year and also there have been many off sick. I have had 6 confirm that they will be present at the focus group but recognise that this is the minimum number needed for a focus group. If a limited number attend then I will need to consider doing it on another day.

9. SIP 3 Interim Progress Proforma Interventionled Project Plan:

To devise and implement an electronic outreach assessment proforma that will meet the needs of the outreach service, the multidisciplinary team and enhance patient care/ safety.

Progress on intervention:

Completed an IT request for change form and this has been discussed and accepted at their meeting. Recently attended a IT/ EPR (electronic patient record) meeting where all the future IT updates and proposals are discussed. Presented my case and this has been accepted as a priority.

Research questions:

Need to evaluate the implementation of the form to see if it: highlights the fact that patient has been seen by outreach to the multidisciplinary team streamlines assessment documentation improves time management enhances patient care improves multidisciplinary team working

Progress on Research input:

Minimal, as awaiting for IT to implement the form, however, now have the Critical care Consultant keen to have input and the Resuscitation team so hoping that this will help to put pressure on the IT team. The observation sheets that we currently use are also changing and I am hoping that this will work in my favour as it is planned that the wards will be using electronic observations from 01/06/2014 and this will hopefully be linked in with my assessment proforma.

General comments:

Feel as though I am not in control as having to wait for others to devise IT programme and put this on the system before I can do any evaluation. Am aware that this may not be completed by the due date and that is frustrating me. IT have their own pressures and whilst I understand this I am finding that I am constantly waiting for others and there is no sense of urgency.

I am sure that there is more that I can be doing behind the scenes and even completing some parts of the SIP but I am becoming a little bit fixated on my form. Maybe we could discuss on 31/03/2014 the aspects that I could complete whilst I am waiting for the form to be put on our patient record system so that I do not leave it all to the last few weeks.

10. SIP 3 Interim Progress Proforma Enquiry-led SIP Project plan: Please detail a brief project plan here Research question/s: Please detail the question/s your research will answer/has answered here. Due to growing concerns about the impact of substance misuse on psychiatric hospital admission throughout the UK, few psychiatric hospitals have been subjected to systemic evaluations in order to reduce admission rates. This is also the case in the local area where I currently work, despite this effort there is little evidence on how these evaluations have helped reduce hospital admission and how staff can best be supported to avoid psychiatric admission for substance misuse patients.

The purpose of this project is to investigate the process and pattern of psychiatric admission for substance misuse patients and determine why/ how it leads to increase in hospital admissions, what has been done/ongoing plans to reduce rates of psychiatric admission. Progress on Research input, Please detail the extent of your progress in clearly defining the problem / issue and the design of potential interventions here: I will focus on and critically analyse a preliminary interview I have already done with a member of staff as well as PSIP outcomes, which identified several issues in the process, and patterns of psychiatric hospital admissions of substance misuse patients. So far my preliminary interview points to the fact that substance misuse is a general problem that has led to increase psychiatric admission rate. It also raises common themes which include, defensive practice and risk assessment process, lack of confidence in decision making, inconsistency in approaches to assessment such as lack of standard assessment forms as well as the potential to over or under estimate the possible impact of an incident, which can then bias staff decisions about risk and actions taken to admit. Progress on intervention: Please detail your plans for the intervention and its evaluation here: SIP statement and consent forms nearly concluded, which clearly state the purpose of the SIP. Organise interview strategy which I have carefully planned in four levels. Level 1- Interview team manager and care coordinator

Level 2- Interview substance misuse worker in teams Level 3- Interview Psychiatric liaison nurse and duty senior nurse in my local hospital Level 4- Interview Nurses on the ward.

Although I am still struggling with Trust Ethical approval, I hope this will resolve soon so that I can start my interviews in Mid-April. I have already spoken to my team and all other potential interviewees. I will wait for ethics approval before I send out the consent form and information sheet. I hope to conclude interviews in May.

General comments: Please place any issues or concerns here: I hope I am on track. I am also managing personal issues at present that impacts on my ability to coordinate and organise myself. I also hope that ethical approval will be granted soon.

End.