Embed Size (px)
Citation preview
What we know • People with learning disabilities are 58 times
more likely to die by the age of 50
• 3 people with ld a day dying avoidably in NHS hospitals
• YET Less than 50% NHS hospitals have LD nurses working in them
What we know
• 2012 = 1,140,000 PLD in England
• 236,000 children
• 908,000 adults aged 18+, of whom 199,000 (22%) are known to GPs
• Increasing number of adults with LD and associated health needs are living into older age
• h4ps://www.improvinghealthandlives.org.uk/securefiles/160302_1749//IHAL2013-‐10%20People%20with%20Learning%20DisabiliRes%20in%20England%202012v3.pdf
Hospitals and health service can be scary places………………………….
Need for transformaRon
PopulaRon who need support CongesRon in current services Cost
How We Communicate %
The other person
hears
Language
Words 7%
How – tone 38%
55 %
The other person sees
Non verbal Gestures and movements
Facial expression
Body posture
Eye contact
Use objects
100 %
Reasonable Adjustments What is reasonable?
Make reasonable care adjustments - consider:
• T Time – take time to work with the patient
• E Environment – alter the environment e.g. quieter areas, reduce lighting and waiting
• A Attitude – have a positive solution orientated focus
• C Communication – find out the best way to communicate with the patient and also communicate this to colleagues
• H Help – what help does the patient need and how can you meet their needs
• The TEACH approach was adapted from the one created by Hertfordshire Community Learning Disability Team
Adjusting Care A Duty under Equality Act 2010
Think Differently ACT Crea/vely
• Learning Disability Reasonable Adjustment alert • Double appointments • Environmental changes e.g. dimmer switches, videos • Information in easy to understand format • Learning disability specific clinics • Health checks and patient held records • Flexible appointment times • No fixed visiting times • Minimising waiting • Increasing support for the person • Hospital Passport
Learning Disability Alerts Over 2700 on system
• Prepare for a person coming in • Make care adjustments • Monitor outcomes and experiences • Improve care
The Learning Disability Protocol for Preparation for Theatre and Recovery • Discuss the patient's needs with them and their family/carers.
• Use ‘comforters’ to relax the patient pre op and in recovery .
• Document and handover to colleagues.
a) Lower levels of noise and light b) Place the patient in a quiet area within recovery c) Ensure parents/carers are present and involved. d) Gradually recover observing how the patient is progressing and ensuring pain has
been assessed and reviewed If the patient is disturbed or distressed in Recovery please consider: 1. Call an anaesthetist to use sedation to induce a relaxed, sleepier state. 2. Increase levels of sedation as required.
Recover patients with
learning disabilities slower than those without
one
• Late 2014 - 9 operations cancelled on one day because a young person with a learning disability in the recovery area was distressed.
• Cost a lot to the individuals and their families but also the hospital many thousands of pounds.
• Since the implementation of the
protocol this has not happened again
More than a diagnosis
Confident
When health professionals get it right
Usual rules don’t apply
Enhancing care and experiences
This is my
Hospital Passport
For people with learning disabilities coming into hospital My name is: I like to be called:
If I have to go to hospital this book needs to go with me, it gives hospital staff important information about me.
It needs to hang on the end of my bed and a copy should be put in my notes.
This passport belongs to me. Please return it when I am discharged.
Nursing and medical staff please look at my passport before you do any interventions with me.
Things you must know about me
Things that are important to me
My likes and dislikes
Mental Capacity Act 2005 If I am assessed as lacking the capacity to consent to my treatment the following people must be involved in
best interest’s decision making Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details Name Relationship Contact Details
My Photo
Buzzers to ease waiting You can go & come back when You are next
Change the environment
Change the environment
• Use dimmer switches to reduce light levels • Use things the person likes eg toys,
games
How the passport changes care
• Filled in by people with learning disabilities and their supporter’s
• Provides a complete view of the person • Not just about ill health • Owned by the individual • Personalises and dignifies care • Enhances patient safety by providing information
about a person who may not otherwise be able to tell health professionals
CURB BADLIP – assessment of capacity
• CURB is used to assess and document capacity: • C Communicate. Can the person communicate his/her decision?
• U Understand. Can he or she understand the informaRon you are giving?
• R Retain Can he or she retain the informaRon given?
• B Balance Can he or she balance or use the informaRon?
If an individual does not have capacity move onto BADLIP to consider if a decision can be made
following a review of best interests
• B Best interest. If the person lacks capacity can you make a best interest decision?
• AD Advanced Decision • L LasRng Power of A4orney Has LasRng Power of A4orney
been appointed? www.gov.uk/become-‐deputy • I Independent Mental Capacity Act Advocate. Is the
person without anyone to be consulted about his or her best interest. In an emergency involve an IMPCA
• P Proxy If unresolved conflicts exist, consider local ethics commi4ee of the Court of ProtecRon appointed deputy
• Hoghton and Chadwick (2010)
Everybody’s Life Has Worth
• Beware of missing serious illness • Find the best way to communicate
• Make reasonable adjustments • Rely more on visual informa/on • Give more /me for processing
Experts by Lived Experiences
• Engage people with LD and families in service design, accreditaRon, delivery, evaluaRon, evoluRon and staff training
• THEN we will get the culture and care right
Behind every behaviour change consider a health reason physical or mental health issue
• See the person NOT their disability
• See my ability NOT my inability
Changing services Responsive Care Outcomes
• Care outcomes specific to the individual. • Reasonable adjustments created flexibly
to respond to needs as they arise to enhance outcomes.
• Care outcomes to be measured and to form core part of contracts.
• To form core quality of service provision, admissions and funding agreements.
• How can healthcare and support workers get things right for people with a learning disability accessing healthcare?
How I can help make change happen? • What can I do to make care better? • How can I make sure it happens? • What else can I do to effect the change that needs to happen?
Useful websites
• BriRsh InsRtute of Learning DisabiliRes www.bild.org.uk
• Assessing Capacity -‐www.nhs.uk/CondiRons/Consent-‐to-‐treatment/Pages/Capacity.aspx
• cardiac specific chariRes for LD include-‐ the Somerville FoundaRon (thesf.org.uk), Max Appeal (maxappeal.org.uk) and the Down's Heart Group (dhg.org.uk)
A picture can say more than words
Books Beyond Words- helping people understand what is happening in their health and in their lives www.booksbeyondwords.co.uk
Easy Read Materials
• Available on website
