Building Success on Strong Foundations - PNA

Psychiatric Nurses Association PNA - <strong>Building</strong> <strong>Success</strong> on Strong FoundationsCollaborative Care Planning - Carraig Mór PsychiatricIntensive Care Unit. Cork Mental Health ServicesTom McSweeney, Cathal Keohane, Denis Long, John Kelleher,Una Howe, Claire Forrest, Alice O’Brien, David Hickey, Keren Lilley, Martin LawlorTom McSweeney c/o Centre for Recovery& Social Inclusion CorkPhone: 0872530573 / 021 4921689Email: info@crsi-cork.com - www.crsi-cork.comIntroduction:The Carraig Mór care plan is named after the unitin which it was conceived and developed, a 19bed psychiatric intensive care unit (PICU) basedin Cork, southern Ireland, delivering care toindividuals with serious mental illness andcomplex needs (primarily psychotic illness andchallenging behaviour). The level of physicalsecurity as a PICU is less than 'secure services'as provided in the Central Mental Hospital,Dundrum, or in Medium or High Secure units inother jurisdictions (Beer et al. 2001).In the current climate of professionaldevelopment, and in order to satisfy governmentpolicy such as “A Vision for Change” (Departmentof Health and Children 2006) it was felt that theRoper, Logan & Tierney model (1996) requiredupdating to facilitate patients participating in theirown care and recovery. Further scope wasneeded to reflect the complex and varied natureof nursing activity in caring for patients as part ofa multidisciplinary team in a Psychiatric IntensiveCare Unit (PICU). Periera and Clinton (2002, p.3)describe working in a PICU service thus: “Careand treatment offered must be patient-centred,multidisciplinary, intensive, comprehensive,collaborative and have an immediacy of responseto critical situations.”A working committee made up of keystakeholders came together to devise a new careplan to meet the requirements for a client centredmodel of nursing, that would be bothrehabilitation and recovery based. The MentalHealth Commission (2005) and the Tidal Model(Phil Barker and Poppy Buchanan-Barker 2005)were contemporary influences in our desire to berecovery-orientated. Carraig Mór PICU aspires tobeing a learning organization, where employeesexcel at “creating, acquiring and transferringknowledge” (Garvin et al 2008, p.109), so formalmeetings were arranged with nursing staff and themulti-disciplinary team, and a sample of currentservice-users were consulted. A qualitative reviewof the findings identified the following themes asbeing key to care planning in Carraig Mór.Aims & ValuesReflect existing practice· It has been historically difficult to quantifythe range of duties and interactionsundertaken by nurses· The previous model was deemedineffective in recording nurses day-to-dayduties and interactions· The guiding principle of the Carraig MórCare Plan was to record existing goodpractice on the unit Promote collaborativecare planning with patients and stafPromote collaborative care planning withpatients and staff· To involve patients in their own care· To support patients with goal setting· Allows patients to assess what staff canoffer towards their recovery· Allows patients to assist in their own careplanning· Laid out in a user friendly form:- Question and answer format- Objective and subjective informationrecorded- Includes the patient’s own lifeexperiencesDevelop therapeutic nurse patientrelationship· With the collaborative approach, the nurseand patient spend more time together· This in turn promotes a therapeuticrelationship· Positive working environment may reducethe risk of incidents Promote multidisciplinaryworking relationshipsPromote multi-disciplinary workingrelationships· Incorporated in the Carraig Mór care planis a social care profile· To promote continuity of care· Optimise patient care and recovery· To promote integrated care pathwayEffective risk management· The incorporation of risk management intocare planning· Initially a risk indicator checklist devised byDeborah Mountain of the Royal EdinburghHospital (2001)· On review we devised our own riskmanagement plan (available atwww.crsicork.com)Promote research based practice· The development of the Carraig Mor careplan was based on relevant researchliterature.· On-going research in-house will informfuture developments.Optimize patient recoveryThe committee undertook the development of theCarraig Mór Care Plan with the expressed hopeof:· Improving patient care· Promoting a collaborative care environment· Assisting with patients’ recovery· Providing client centred care principlesDevelopmentUsing these points to aid development a finaldraft was produced, which was approved forprinting from September 2006, with a review dateof January 2008. The care plan was thenintroduced on a phased basis; this consisted ofcompleting a new type care plan for newadmissions, and two transitions a week for thosewho were inpatients at the time of the changeover, allowing different members of staff to beorientated to the care plan gradually under thesupervision of members of the workingcommittee. Initial response from the client groupwho were already inpatients during the transitionwas encouraging, with clients reporting approvalthat they had an input to their own care plan.There was also positive feedback from nursingstaff in relation to new admissions, with reportsthat the new care plan allowed them to get toknow the client during a much shorter space oftime. They also reported to the workingcommittee that the new care plan was a muchbetter tool for assessing client’s needs bothmentally and physically. The introduction of therisk indicator in the care plan was also welcomedas it allowed easier security planning.ConclusionIn January 2008 the Carraig Mór care plan wasreviewed and amended in a number of areas,including social work practice and riskassessment, as part of its ongoing developmentand improvement. There have since beenupdates to incorporate new legislation andguidelines, such as the Department of Health andChildren’s report (2008) “<strong>Building</strong> a Culture ofPatient Safety”.In order to enable mental health services to pooltheir resources, further revisions of this evolvingcare plan will be published on our website atwww.crsi-cork.com. We would welcomefeedback and encourage others to make theirown local adaptations – provided they includeattribution to the copyright holders, and a copy ofthe new adapted document is sent back to us.AcknowledgementsWe wish to acknowledge the support of HSEadministration and the multi-disciplinary seniormanagement team, particularly Ms PaulineO’Donovan, Director of Nursing, and Dr EamonnMoloney, Clinical Director. We also want to thankDr Anne Schofield.Development contributors were Helena O’Connor(Risk Management) and Sinead Lawless (SocialWork).ReferencesBarker, P. & Buchanan-Barker, P., 2005. The TidalModel: a guide for mental health professionals.London: Brunner-Routledge.Beer, M.D. Pereira, S.M. & Paton, C., 2001.Psychiatric intensive care. London:Greenwich Medical Media.Department of Health and Children, 2006. Avision for change: report of the Expert Group onMental Health Policy. Dublin: Stationery Office.Department of Health and Children, 2008.<strong>Building</strong> a culture of patient safety: report of theCommission on Patient Safety and QualityAssurance. Dublin: Stationery Office.Garvin, D.A. Edmondson, A.C. & Gino, F., 2008. Isyours a learning organization?Harvard Business Review, 86(3):109-16, 134.Mental Health Commission. 2005. A vision for arecovery model in Irish mental health services:discussion paper. Dublin: Mental HealthCommission.Mountain, D., 2001. Risk Indicator Checklist.Edinburgh: Royal Edinburgh Hospital.Roper, N., Logan, W.W. & Tierney, A.J., 1996. Theelements of nursing. 4th ed. NewYork: Churchill Livingston.Periera, S. & Clinton, C. eds., 2002. Nationalminimum standards for general adult services inpsychiatric intensive care units (PICU) and lowsecure environments: mental health policyimplementation guide. London: Department ofHealth.4