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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 Nurse Pene Stevens – Head of Learning Disability Nursing Steven Taylor – Senior Practitioner Penny Moroney – Senior Practitioner.

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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 Nurse

Pene Stevens – Head of Learning Disability Nursing

Steven Taylor – Senior Practitioner

Penny Moroney – Senior Practitioner


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?


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?


Figure 5 showing the number of admissions for people with

learning disabilities between July 2008 and July 2010

12

10

8

6

Number of Admissions

4

2

0

0

100

200

300

400

500

600

700

Number of people with learning disabilities using Trust services

Data Analysis


Patient Centre Flagging

  • GP Registers?

  • Hospital Information Team provided us 1500 names F819 ICD- 10 code

  • Manually inputting on Patient Centre


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


QlikView Dashboard

  • EKHUFT bought QlikView for Business and financial management

  • Information Dept adapted it for clinical applications


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.


Learning Disability Link role

  • Formalised links between EKHUFT & KCHT

  • Exploration of what Learning Disability Link Nurse role meant


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?


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


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.

Outcomes- Case studies


Individual with urology issues – repeated admissions for washouts via A&E.

CLDN input has most washouts in the community.

Outcomes – Case studies


Themes

  • Responsive service

    • Specialist Nurse intervention

  • Increasing productivity

  • Data quality

  • Gap analysis

    • May – 79 Admissions, 10 referrals.

  • Other uses for QlikView


What’s next?

  • Evaluation

    • Individual outcomes

    • Cost savings

  • Publication?

  • Further adaptations to QlikView


For further information

Daniel Marsden – Practice Development Nurse for people with learning disabilities

Email Daniel.marsden@nhs.net

Mobile 07786 171008

www.ekhuft.nhs.uk/learningdisabilities

Twitter: @dmarsden49


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