PICU OUTREACH SERVICE Willow Suite PICU Little Brook Hospital

1. PICU OUTREACH SERVICEWillow Suite PICULittle Brook Hospital By Ramanah Venkiah & Thembani Mloyi March 2009

2. Willow Suite PICU Service Definition • 12 mixed sex beds • for acutely disturbed individuals aged 17-65 yrs detained under the MHA’83 • higher (skilled & experienced) staff to patient ratios • short stay treatment & promote care in least restrictive environment • MDT Approach to Care

3. Collaborative Approach Partnership Working Expert Advice Response Time (24hrs) Ongoing Support PICU Outreach Response Time (24hrs) Explore all Care Options Fast Track Option Follow Up WORKING IN PARTNERSHIP Improvement Innovation

4. Explore all care options to maximise potential of least restrictive local environment Clear expectations, achievable outcomes & agreed goals Informed choice though education support and advice Ongoing Support before during & after episode of care in PICU WORKING IN PARTNERSHIP Benefits To Patients/Carers/Referrers

5. HOW DID THE TEAM ACHIEVE IT AIM • Caring for Patients in the Least Restrictive Environment • Follow up Review of Policies (2003) • Consultation with all Professionals • PICU Outreach Document/Approved for Pilot Study (Sept 04 to Sept 05) • It is the responsibility of all PICU’s/Low Secure Services to develop effective networks with other agencies: • To maximise the quality of the care package available to individuals • To maximise engagement and therefore improve quality of life and future wellbeing for individuals • To maximise the available resources and empower the patient to choose what is best suited to their needs • To reduce stigma attached to treatment in a secure environment • The PICU environment should be the “Least restrictive environment” as clinically possible (National Service Framework for Mental Health) • (National Minimum Standards for PICU and Low Secure Environments, DoH May 2002)

6. PATIENT AND CARER’S INVOLVEMENT • Involved at all Stages of Care • Clear Expectations • Set Achievable Outcome • Work Towards Agreed Goals • Advocacy Network

7. PICU Outreach Service Background Information Pilot Study January 2004 to September 2004

8. PICU Outreach Service

9. PICU Outreach Service Key Results (Figures from PILOT STUDY January 2004 - September 2004)

10. PICU Outreach Service KEY FINDINGS Patient Questionnaire • Patient Statement: “Support from Willow Suite PICU Outreach was a great help to myself and my family”. Professional Questionnaire • Professional Statement: “Effective service. PICU Outreach Team was easily accessible and very supportive”. Patient Satisfaction Survey

11. PICU OUTREACH SERVICE March 2009

12. PICU Outreach Service Service Definition “The identification of the critically ill or deteriorating patient is the key to preventing admission or readmission to the critical care facility” (DoH 2000). • PICU Outreach Service hence developed, a Multidisciplinary Team Approach for Caring for Patients in the “Least Restrictive Environment” and is very much based on the ethos of Risk Assessment and Risk Management.

13. PICU Outreach Service Objectives • avert unnecessary admissions to PICU • to provide a specialist assessment, support & patient management recommendations • facilitate timely admission to the PICU and discharge back to less restrictive environment • share intensive care risk assessment and risk management skills and expertise through an educational partnership • promote continuity of care • ensure continuous thorough audits and evaluation of the PICU Outreach Service

14. PICU Outreach Service Key Characteristics • assessments within a 24hr period of receipt of referral • assessments carried out by PICU Outreach Assessment Nurse occasionally jointly with an Associate Specialist/SHO • partnership working with the care co-ordinator or catchment area team • involvement ceases when patient is discharged in caseload review or CPA meetings

15. PICU Outreach Service Who is it for? • The service is provided to the population of the West Kent Area.

16. PICU Outreach Service Referral Sources • In-patient Services • Community • Prisons • Out of Area

17. PICU Outreach Service Referral Procedure

18. PICU Outreach Service Response to Referrals • within 24hours of receiving a referral • by RMO/Associate Specialist/SHO with PICU Outreach Assessment Nurse • On call service from Friday 21:00 Hrs to Monday 09:00 Hrs • from Out of Area will be dealt with immediately following discussion of current presentation

19. PICU Outreach Service Caseload Involvement • follow-ups on referrals • to be managed on current location • consideration for PICU admission • MDT weekly review • review progress • medication review • increase support • further recommendation • agreed on joint review • discharge form caseload • attending CPA meetings • for prevented admissions to PICU (in caseload) • discharge CPA for those admitted to PICU • recently discharged from the PICU (catchments team) • review visits • on in-patient settings • Community (working alongside with Care Co-ordinator)

20. PICU Outreach Service Discharge Process • discharge from caseload will occur when initial risk has minimised • discharge in caseload review & CPA meetings

21. PICU Outreach Service OPERATION Team Base • Little Brook Hospital, Willow Suite, Dartford • 01322 622222 ext.2033/3789/3792 • 01322 622033 Fax 01322 622497 Hours • 0900-2100 - Mon to Fri • 2100 Fri – 0900 Mon - On-Call Service • Bank Holidays – On-Call Service

22. PICU Outreach Service The Team: • Prof. Mathews (Consultant Psychiatrist) • Dr Yogendran (Associate Specialist) • Ramanah Venkiah (Willow Suite PICU Manager) • Thembani Mloyi (Assessment Nurse) • Mubarak Mahama (On-Call Assessment Nurse) • Joy Parsons (Ward Secretary)

23. RANGE OF TREATMENT AVAILABILITY WITHIN PICU • Patient Informed Choice • Drug Free assessment • Physical Investigation • Medication (NICE GUIDANCE) • Alternative Therapies

24. PICU Outreach Service Key Results (Figures from June 2006 – March 2007)

25. PICU Outreach Service Key Results (Figures from April 2007- March 2008)

26. PICU Outreach Service Key Results (Figures from April 2008- December 2008)

27. EVIDENCE OF ACHIEVEMENT • First and currently the ONLY PICU Outreach Service in the UK • Reduction in Admissions • Successful Management of Patient in the “Least Restrictive Environment” • Enhanced Working in Partnership with Referring Team and Adult Acute / Community Mental Health Services • NAPICU Governance Network • Advance Directive

28. EVIDENCE OF ACHIEVEMENT • Maintaining Patient and Carer’s Involvement • Relapse Prevention and Recovery Model • Health Economics/Financial Saving • Admission survey at a National Level sponsored by NAPICU • BPRS Audit at National Level • Building Extension / Therapeutic Ward Based Therapy • Seamless Continuity of Care

29. FUTURE DEVELOPMENTS & VISION OF AN IDEAL PICU • Service User’s to continue to actively Involve in the development of the Service • Publication on the Effect of PICU Outreach Service on the Mental Health Care Delivery in Kent • Therapeutic Activities Audit • Reduction of Restraint and use of seclusion • To fully implement the Well-being support programme • Expand on the hours of PICU Outreach service • Service Development/Income Generated

30. Any Questions??? Thank You