Physical Health Assessment in The State Hospital

1. Physical Health Assessment in The State Hospital Karen Burnett APIC / Learning & Development & Allan Burnett Senior Rehab Instructor Sports & Fitness The State Hospital

2. INTRODUCTION The State Hospital

3. ABOUT US The State Hospital is one of four high secure hospitals in the UK.It is part of the NHS in Scotland (since 1994) and provides a national service for Scotland and Northern Ireland. The State Hospital

4. ABOUT US As a Special Health Board is accountable to Scottish Ministers through the Scottish Government. There are 140 high-secure beds for male patients requiring maximum secure care: 12 specifically for patients with a learning disability. The State Hospital employs around 700 staff. The State Hospital

5. ABOUT PATIENTS 2013/14 77% of the patients are ‘restricted’. The majority have a primary diagnosis of schizophrenia.The average length of stay is 7.2 years, ranging from around two months to over 40 years. The State Hospital

6. ABOUT PATIENTS All patients are male - The women’s service closed in 2007/08 in line with the national plan for no high secure provision for females. The average age is 41 years. The State Hospital

7. OLD TO NEW!! In 2008 the State Hospital signed the contract to begin the transformation The State Hospital

8. In 2011 the new State Hospital was complete! The State Hospital

9. PATIENT ACTIVITY There are seven purpose built patient activity centres within the Skye Centre: Atrium (i.e. social club / hobbies) Craft & Design Patient Learning Primary Care (i.e. Health Centre) Sports & Fitness Woodcraft Gardens & Pet Therapy The State Hospital

10. Health Centre The Health Centre aims to meet and support most primary healthcare requirements of patients. The State Hospital The State Hospital

11. HEALTH CENTRE • Admission Bloods • ECG • Optician • Dentist • Podiatrist BBV assessment by APIC The State Hospital

12. SPORTS & FITNESS Offer many varied sports and activities throughout the day, in the evenings and at weekends. The State Hospital

13. PHYSICAL ASSESSMENT PROCESS Patient Admission Pathway Variance Analysis Tool What is it? The State Hospital

14. NURSING INTERVENTIONS Day of admission • Complete particulars of admission and pass to Health Records • Complete Observation Level plan in PMVA section of RiO • Complete Blood Borne Virus risk assessment on RiO • Physical examination completed on RiO and forwarded to Health Centre (including neurological examination & general medical history completed) • Initial admission risk assessment tool completed on RiO (as per PMVA Policy) • Carer/relative successfully contacted The State Hospital

15. BY DAY 7 • Nutritional Screening Tool Completed on RiO • Information Booklets (i.e. Patient Info, Hosp Info, Section Info, MWC Info, etc) explained and given to Patient - in a relevant and understandable format. The State Hospital

16. NUTRITIONAL SCREENING TOOL Why must we Nutritionally Screen Patients? • National Standards (Scotland 2003) • Recommended as good practice (BAPEN 2003) • To be able to manage their nutritional care appropriately • To manage any risks associated with their nutritional care • To provide optimum nutritional care to support their recovery. The State Hospital

17. NST SECTION 6 The State Hospital

18. DAY 14 • BEST-Index Assessment Completed on RiO(+ Care Plan updated) • PECC Nursing Assessment Completed on RiO(+ Care Plan updated) • Complete LUNSERs/GASS and pass to Health Records(if approp, e.g. if on anti-psychotic medication) • Nutritional Care Plan completed The State Hospital

19. BY DAY 42 • Admission fitness assessment completed • Dietetic report completed on RiO and MDT informed Dietician discusses content of report with patient prior to Admission Case Review and log conversation in RiO Progress Notes The State Hospital

20. PHYSICAL ACTIVITY The State Hospital

21. ADMISSION PHYSICAL ACTIVITY PATHWAY Initial Sports & Fitness assessments completed: - PARQ, Fitness assessment, Motivation & goals assessment Hub fitness room induction completed Sports & Fitness induction completed Drop-ins to Sports & Fitness Skye Centre induction completed Referred to Sports & Fitness and allocated sessions The State Hospital

22. PHYSICAL ACTIVITY REFERRAL FORM Referral discussed at Clinical Team Meeting – decision made to attend Sports & Fitness Self referral / Drop-in Patient interviewed by member of Sports & Fitness team Referred to Clinical Team Referrals Committee - Discussed at meeting Patient refuses to interact Patient stops attending activity Refused – Referral returned to Key worker withexplanation Approved – Referral sent to Sports & Fitness Decision regarding best programme for patient – 1:1 sessions Group sessions Ward activities Outside gyms 12 month assessment Placement within Sports & Fitness The State Hospital

23. THE STATE HOSPITAL LDP 2013-2016 TARGET • National Target of 30mins x 5 days per week • The State Hospital target of 30mins x3 days per week The State Hospital

24. SPORTS & FITNESS TIMETABLE Team/individual sports/coaching Course work/ hub work / fitness assessments Fitness suite / training General referred patients – various activities The State Hospital

25. POSITIVE ACHIEVEMENTS • Sports Leaders Award • Olympic Games&Commonwealth • Sportsman's Dinner & Award Ceremony The State Hospital

26. CHALLENGES • Motivation – Patients • Competing with other disciplines & activities e.g. Psychological therapies, OT sessions, shop • Resources • Old sports routine The State Hospital

27. THE WAY FORWARD 2015 • Ensuring Physical Health is everyone's responsibility • Running within the hospital grounds • Cycling • Walking routes • Physical Activity Leaflet • Collaborative working • Trainee health psychologist Health Improvement Model The State Hospital

28. WHAT DO YOU DO? The State Hospital