hong kong hospital authority convention 2013 · 2013-05-28 · scope of nurse consultant practice...
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Hong Kong Hospital Authority Convention 2013
Multidisciplinary Case Management Model for People
with Severe Mental Illness 15 May 2013
Jolene Mui
Nurse Consultant
Community Psychiatry
The role of Nurse Consultant (NC) represents a new and dynamic area of advanced nursing
practice in contemporary Hong Kong health care.
Scope of Nurse Consultant Practice Hospital Authority, Hong Kong
In collaboration with multidisciplinary team, NC is responsible for: 1. Strategic planning and service development, 2. Development of care delivery model, care pathway/guidelines, risk
identification and stratification; 3. Ensure service quality and staff competency; 4. Monitor standards and outcome; 5. Direct care and management of complex and high risk cases; 6. Facilitate primary care development and community networking; and 7. Provide consultation service.
4
Improve clinical care
Helping people to stay healthy
毒 如 蛇 蠍
影 片 Experience sharing in Community Psychiatric Service
Problems with inadequately funded
CPS/unplanned closure of beds Service provision could only geared towards risk aversion Patients with SMI were often cycled rapidly between psychiatric
emergency services, inpatient psychiatric hospital units and a return to the
community without adequate provision for aftercare.
Recovery
Service
Risk Aversion
Strategic planning and service development :
The vision of the future is of a person-centred service
based on effective treatment and the recovery of the
individual
Hospital Authority Mental Health Service Plan for Adults2010- 2015
Hospital Authority Mental Health Service Plan for Adults2010- 2015
Strategic planning and service development
Set the stage
To develop unique care delivery model to meet patient `s
needs effectively.
3 – tiered multidisciplinary Case Management Model in CPS
Multidisciplinary approach to meet the multiple needs of patients.
One single point of entry to improve the accessibility of service consumers
Immediate risk
• In relapsed
• In acute state
High risk
• Poor drug compliance
• Intense emotional problems
• SMI with young children
Low risk
• Stable cases with chronicity of illness
• Multiple functional disabilities
High intensity short term care package
A. Crisis Resolution
B. Assertive community out-reach ( pre-crisis intervention)
Complicated care package
• Psycho-therapeutic intervention :
• -symptom management.
• -counseling
• -cognitive behavioral therapy
• -family therapy
Medium
High
Low
Complexity of formulation Risks & Needs stratification Complexity of intervention
Low intensity care package
-Maintenance therapy
-Peer support
Objective exchange rate of case load among the 3 tiers :
(1) High: (2)Medium : (3) Low
Risk
Pathfinder Risk assessment
Needs
Camberwell Needs Assessment
•The stratification is an essential process to ensure appropriate workload distribution among case managers. •The case allocation with references to patients` needs and matching with case managers` expertise allows the care delivery to be more focused and this is essential to drive for quality.
Stratify patients into 3 tiers complexities: high, medium low.
The uniform assessments and outcome measures ensure standard
Service provision
Service development and clinical leadership
-
To build a streamlined and coordinated workforce for
community psychiatric care of General Adults.
.
Integration all community psychiatric service of General Adult,
EASY & Forensic under the same Team in year 2010
Leading the whole Team towards the same vision
Continuous Quality Improvement
Formulation of fidelity scales.
To ensure service quality
Creation of the New model with service protocol/ risk & needs
stratification /care package/ care pathway.
Uniform Assessment
Clinical Guidelines
Data Management
Evidence-Based, Best Practice
Levels of Care
Outcomes Fidelity
Develop Fidelity Assessment Determining whether the intervention is conducted as planned and is consistent with
service elements delineated including structures & goals.
Develop Fidelity Assessment
• Components
a. Team structure: case load/staff capacity
b. Team process : guideline/procedure
c. Diagnostic and Treatment intervention:
ISP/care package Community care
d. Organization: admission & discharge
criteria
e. Monitoring: outcome
Clinical practice and consultancy
-
To provide clinical consultancy service across multidisciplinary groups/community partners.
.
On going supervision to case managers from a variety of backgrounds ( nurse, OT, social worker )
Working directly with clients of having high risk /complex needs
Ensure service quality and staff competency
-
Continuous review, organize & deliver training to
multidisciplinary staff working in Community Psychiatric
Service as well as CPNS of HK
.
Design the training packages in different tiers under the new model.
Arrange training to multidisciplinary staff working in CPS.
Develop training programs for case managers.
3 tiers Case Management Model
Immediate risk
• Active psychosis which
affects patient's ADL
• Immediate risk to self
and others
Medium risk • Doubtful drug compliance
• Fluctuating mental state
• Intense emotional problems
• SMI with young children
Low risk
• Stable cases with chronicity of illness
• Multiple functional disabilities
High intensity short term care package
A. Crisis Resolution /pre-crisis intervention
B. Assertive out-reach
Intensive care package
Psycho-therapeutic intervention :
-symptom management.
-counseling
-cognitive behavioral therapy
-family therapy
Medium
High
Low
Complexity of formulation Risks & Needs stratification Complexity of intervention
Standard care package • Maintenance therapy
• Close collaboration with
community partners.
• Enhance patient self care and
• functional ability
Enhanced community networking
-
To build strategic partnership
Formalized network with all relevant community partners . Joint projects to link up professional staff; people from
different strata of society (e.g. community agencies / volunteers / carers / business enterprise / families ) to provide share care to clients/families/carers /public.
To provide consultation to community partners.
Research & evidence based practice
-
To improve service outcome through evidence-based
practice
Conduct research
s
Bressington, D. T., Mui, J., Cheung, E. F. C., Petch, J., Clark, A. B.,
& Gray, R. (2013). The prevalence of metabolic syndrome
amongst patients with severe mental illness in the community in
Hong Kong – A cross sectional study. BMC Psychiatry, 13, 87.
doi:10.1186/1471-244X-13-87
Bressington, D., Mui, J., & Gray, R. (in press). The effects of
medication-management training on clinicians’ understanding
and clinical practice in Hong Kong. Nurse Education Today.
doi:10.1016/j.nedt.2012.10.021
Bressington D., Mui, J., & Gray, R. (2013). Factors associated
with antipsychotic medication adherence in community-based
patients with schizophrenia in Hong Kong: A cross sectional
study. International Journal of Mental Health Nursing, 22, 35-
46. doi:10.1111/j.1447-0349.2012.00830.x
Chui, W. W. H., Mui, J. H. C., Cheng, K. M., & Cheung, E. F. C.
(2012).
Community psychiatric service in Hong Kong: Moving towards
recovery-oriented personalized care. Asia-Pacific Psychiatry, 4,
155-159. doi:10.1111/j.1758-5872.2012.00206.x
Cheng, K. M., Chan, C., Wong, R., Leung, K. T., Mui, J., Chui, W.,
& Cheung, E. (2012). Integrated care pathway for the
personalized care programme for patients with severe mental
illness in Hong Kong. International Journal of Care Pathways, 16,
72-75. doi:10.1258/jicp.2012.012006
Chan, S., Mui, J., Shing, K. C., Chien, W. T., Chan, A., Chan, D., &
Ip, W. Y. (2011). “Growing in Happiness”: Pilot study of a
mental health promotion programme for children with
Chui, W. W. H., Mui, J. H. C., Cheng, K. M., & Cheung, E. F. C.
(2012).
Community psychiatric service in Hong Kong: Moving towards
recovery-oriented personalized care. Asia-Pacific Psychiatry, 4,
155-159. doi:10.1111/j.1758-5872.2012.00206.x
s
Chan, S., Mui, J., Shing, K. C., Chien, W. T., Chan, A., Chan,
D., & Ip, W. Y. (2011). “Growing in Happiness”: Pilot
study of a mental health promotion programme for
children with mentally ill parents. Hong Kong Journal of
Mental Health, 37(1), 22-30.
Yeung, C. L., Kwok, S. K., & Mui, H. C. (2011). An
investigation of an RFID-based Patient-Tracking and
Mobile Alert System. International Journal of Engineering
Business Management, 3(1), 50-56.
Mui, J. (2011, June). Keynote address: Clinical practice
innovation. Paper presented at the 5th Hong Kong
International Nursing Forum, Hong Kong SAR, China.
Cheng, K. M., Mui, J., Wong, R., Leung, K. T Chui, W., &
Cheung, E. (2012). Integrated care pathway for the
personalized care programme for patients with severe
mental illness in Hong Kong. International Journal of Care
Pathways, 16, 72-75. doi:10.1258/jicp.2012.012006
Mui, J., Fong, S. Y., Lin, K., & Chan, E.. (2011, September). Meaning of
recovery from people with severe mental illness. Paper presented at
2011 Institute of Mental Health Conference, Hong Kong SAR, China
Mui, J. (2012, August). Advanced nursing practice: Global vision – global reality
Paper presented at the 7th International Nurse Practitioner/Advanced Practice
Nursing Network Conference, United Kingdom
Mui, J. (2010, December). Comprehensive management models. Paper
presented at the 2nd HK-UK Joint International Conference, Hong Kong SAR,
China.
Mui, J. (2009, November). Nurses’ contribution to contemporary disease
management. Paper presented at The Fourth Conference, Macau-Hong Kong
Nursing Conference. MacauSAR, China
Mui, J. (2009, August). 如何運用綜合能力及家庭參與提升病人成效. Paper presented at中華護理學會 一百週年庆 at Peking
s
This New Model sets
the stage for us to move
forward…..
STRUCTURE: Establish multidisciplinary case
management model
PROCESS : Formulate comprehensive assessment
tools
- Risk & Needs assessment
-Individual patient care plan
- Clinical Case Review
OUTCOME measures: Needs/risks/measurable
Mental/physical/psychological/social…
COMMUNITY PARTNERS:
Established local platform: SWD. NGO. Police.
Housing
Collaboration guideline with ICCMW
Brings in more
recovery elements
into the service model
Research:
Meaning of
RECOVERY
Draws on consumer perspectives
•Symptom amelioration • Enhancement of functional capability •Improvement of health.
Clinical (medical) Recovery
a meaningful, satisfying and valued life dignity
hope aspiration confidence
Self determination
Meaning of Recovery……two sides…
Clinical (medical) Recovery Practioner Defined recovery : symptom reduction health improvement; enhancement of functional capability;
Personal (life)
Recovery
Service user defined recovery
Meaningful, satisfying and valued life.
It was what have focused in the past
That is what we are planning to do more
Equally important
To actualize RECOVERY
We have to combine both the
`Clinical Recovery` & `Personal
Recovery
Employed the first peer specialist in
HK in 1st September 2011
Recovery-focused Practice
stigmatization
H.K. Connection (鏗鏘集)
我病了……但我會快樂
Strategy to overcome stigma
Youth Ambassador Program to increase the resilience of children of psychotic parents
Thank you