06 / 12 / 2016
A pioneering initiative at Abertawe Bro Morgannwg University Health Board is helping to allay the fears and concerns of patients with learning disabilities heading into the operating theatre.
The challenge and the context
People with learning disabilities and/or mental health issues find it difficult to access treatment. Anxiety, fear, inability to communicate and previous bad experiences of clinical environments can drive the potential for self harm and harm to others.
Numerous reports exist about poor care and difficulties in accessing treatment through unmet reasonable adjustments. Traditionally, sedation or clinical holds (restraints) were used to gain compliance for treatment leading to bad experiences or fear of clinical environments.
What was done
The Paul Ridd story and his tragic death at Abertawe Bro Morgannwg University Health Board inspired the approach. His brother and sister felt their concerns were not listened to. Medical staff missed vital clues due to clinical overshadowing, as they failed to see the person and not the condition.
The Soothing Patients Anxiety experience, SPA, was born through addressing key reasonable adjustments, putting citizens at the centre of service redesign.
The service is based on key themes:
- Every person is un1que – no clinical overshadowing.
- Person-centred care met through essential reasonable adjustments.
- Communication and information – a carer’s questionnaire alongside a learning disability passport provide a record of the person's essentials. This was an essential start in getting to know the person, though actually meeting the person is preferable. Pre-op visiting and a pre-appointment meetings were introduced. Direct observation is conducted to observe how the person is in the actual environment, allow them to gain familiarity with staff and clinical areas. Healthcare professionals establish trust and rapport with the person.
- Minimal additional anxiety – the approach focuses on making those essential reasonable adjustments such as reduced waiting times, minimal changes in staff and limiting the number of new clinical areas. The service also made key adjustments to any procedures and policies that acted as a barrier to treatment, such as not changing from their outside clothes, wearing an identity bracelet or applying monitoring until they were asleep.
- A positive memorable experience for the right reasons – the service developed a variety of person choice distraction techniques, from music, film, sensory lights and themed visits. This has led to minimal use of sedation or clinical holds. This means no requirement for a hospital bed, minimal attendance time, entry and early discharge directly from the recovery room. They deliver a special day, a memorable visit for the right reasons “every patient has their un1que story”.
- Continuous improvement – this category of patient is unpredictable. While there may be common principles that may alleviate anxiety, it depends very much on the person at that moment of time. This has led to the service being designed and evolving through interactions with patients and their carers, service users resulting in small iterative 'plan-do-study-act' (PDSA) cycles and repeating aspects that have worked being options for future patients and being open to rapid change and flexible.
This has been a three-year journey to date and is continuing to evolve. Citizens are at the centre of our service redesign and their feedback informs future care for others. The approach considers any idea from any service industry striving to give the best possible customer experience and patient satisfaction.
Results and benefits
- Treating individuals who previously were unable to receive treatment.
- A reduction in techniques that take control from the person, such as sedation or clinical hold.
- No hospital bed is used and treatment is on a day case basis
- Limited clinical environment – patients are admitted and discharged within the small operating department suite.
- Continuous quality improvement facilitated through feedback from patients, carers, service users, post discharge telephone questionnaire and PROM feedback forms.
The main obstacles to overcome are attitudes and fixed mindsets, policies and processes. The challenge to be embraced is finding new, innovative and creative solutions to provide safe efficient equitable care.
- Every patient is un1que.
- Carers and service users are equal partners.
- Treat the person.
- Planning is everything.
- Don't be afraid to challenge preconceived ideas, mindsets and processes.
- Don't fear small tests of change through PDSA cycles.
- Person-centred care is essential.
- Partnership and teamwork are essential.
Want to find out more?
Get in touch with Paul Harris, theatre specialist trainer, operating department practitioner, at firstname.lastname@example.org or Dr Shakeel Moideen, consultant anaesthetist, at email@example.com