Download - Daniel Marsden – Practice Development Nurse Pene Stevens – Head of Learning Disability Nursing
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Using informatics to target use of Specialist Nurses to improve hospital
care for people with learning
disabilities
Daniel Marsden – Practice Development NursePene Stevens – Head of Learning Disability NursingSteven Taylor – Senior PractitionerPenny Moroney – Senior Practitioner
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Background
• Current Monitor Compliance Indicator– Does the trust have a
mechanism in place to identify and flag patients with learning disabilities and protocols that ensure that pathways of care are reasonably adjusted to meet the health needs of these patients?
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Hospital Context
• One F/T Practice Development Nurse
• 1400 beds over 3 Acute Hospitals – 3rd biggest Trust in UK
• How do I develop practice of over 7000 staff?
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Data Analysis
Figure 5 showing the number of admissions for people with
learning disabilities between July 2008 and July 2010
0
2
4
6
8
10
12
0 100 200 300 400 500 600 700
Number of people with learning disabilities using Trust services
Nu
mb
er o
f A
dm
issi
on
s
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Patient Centre Flagging
• GP Registers?
• Hospital Information Team provided us 1500 names F819 ICD- 10 code
• Manually inputting on Patient Centre
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Inquiry into use of data
• Realised Patient Centre Flag was not having the desired effect
• Leadership for Informed Practice had me question again how we could track
• EKHUFT Information team solution QlikView
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QlikView Dashboard
• EKHUFT bought QlikView for Business and financial management
• Information Dept adapted it for clinical applications
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QlikView – Excel Spreadsheet
• Behind the dashboard is an Spreadsheet that draws information out of Patient Centre every 2 minutes.
• The blue dots represent people with learning disabilities Flagged on Patient Centre.
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Learning Disability Link role
• Formalised links between EKHUFT & KCHT
• Exploration of what Learning Disability Link Nurse role meant
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Referrals to Learning Disability Link Nurses
• One Nurse for each Hospital
• Who would be referred and why?
• How would we create an audit trail and evaluate?
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Refining the questions
• Referrals for people– visiting A&E > 4 times or – being admitted > 3 times in the
last year.
• Excel spreadsheet to gather details and outcomes.
• 30 referrals in the last 14 weeks
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Outcomes- Case studies
• One man experienced significant bowel pain and diarrhoea.
• 12 visits to A&E and 8 admissions.
• Discharge planning with CLDN, reduced pain and discomfort.
• One man visited A&E 50 times in the last year ~ £10,000
• Collaborative intervention = 9 weeks without visits.
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Outcomes – Case studies
• Individual with urology issues – repeated admissions for washouts via A&E.
• CLDN input has most washouts in the community.
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Themes
F819 Learning Disability prevalence EKHUFT vs Local Population
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12
Month
% LD
Prev
alenc
e Rate
Number of admissions per 1000 (All) Number of admissions per 1000 (with Learning Disabilty)
• Responsive service – Specialist Nurse intervention
• Increasing productivity
• Data quality
• Gap analysis – May – 79 Admissions, 10
referrals.
• Other uses for QlikView
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What’s next?
• Evaluation– Individual outcomes– Cost savings
• Publication?
• Further adaptations to QlikView
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For further information
• Daniel Marsden – Practice Development Nurse for people with learning disabilities
• Email [email protected] • Mobile 07786 171008 • www.ekhuft.nhs.uk/
learningdisabilities • Twitter: @dmarsden49