The effects after 1 year of the introduction of a token economy system into a long-term male psychiatric ward of 45 mainly schizophrenic patients are described. The main objectives were (1) to define the limits of such programmes in "average" National Health Service conditions, where additional resources in staff, finance, and facilities are very limited and (2) to introduce the principles and techniques of behaviour modification to nursing staff. The programme succeeded in reducing social withdrawal and apathy and in increasing self-care skills and involvement in constructive activity. There was no change in the level of socially embarrassing behaviour. The major limitation affecting the maintenance of the programme was found to be the rapid turnover and unpredictable changes in nursing staff. It was concluded that such programmes are feasible with very little in the way of increased resources, and that such efforts will continue to be necessary in view of the existing large numbers of long-term patients and the slow but significant accumulation of new patients.
Introduction
The transition of care from hospital to home is a high-risk time for older adults. The Partners at Care Transitions (PACT) programme aims to improve safety and quality of care transitions. We aimed to test the feasibility of using the Partners at Care Transitions Measure (PACT-M) to evaluate older adults’ experiences of the transition from hospital to home in an Inner London Integrated Care Trust and to identify factors impacting transition quality.
Methods
The PACT-M, a validated patient-reported questionnaire designed to evaluate care transitions, was administered to patients ≥65 years at 7, 30 and 90 days post-discharge. Likert scores were analysed quantitatively and manual thematic analysis performed on free-text comments.
Results
101 participants were recruited. Mean age 77.8 years. 84, 70 and 65 participants completed follow-up at 7, 30 and 90 days, respectively.
Factors impacting patients’ experience of transition quality are shown in Table 1.
Conclusions
Introduction
GSTT@home is a hospital@home providing multi-disciplinary acute care in peoples’ homes throughout Lambeth and Southwark. AMBER is an internationally recognised care bundle to improve care for hospital inpatients where survival is uncertain. The bundle prompts recognition of survival uncertainty, communication and advance care planning (ACP)- principles relevant to many hospital@home patients. This quality improvement project aimed to embed these principles into GSTT@home by adapting AMBER to this community setting.
Methods
Cycle 1 Plan- Determine whether @home patients might benefit from principles of AMBER. Do and Study- Audit patients >80 years that died within a 3-month period after @home admission (January–June 2018); one in 10 patients died (10.9%), median age 82 and median CFS 8. Act- Inpatient AMBER bundle adapted for @home setting to systemically identify and prompt ACP. Cycle 2 Plan and Do- AMBER@Home bundle formally introduced and piloted with @home, education using posters and lanyard cards.
Study
Audit use of AMBER@Home for patients >80 years who died within three months of discharge from @home (August–October 2019). Act- AMBER@Home incorporated into daily handover document. Cycle 3 Plan and Do- Further education embedded AMBER@Home, increased consultant and GP support. Study- Use of AMBER@Home re-audited as above for November 2019–January 2020.
Conclusions
Using AMBER@Home appears to have changed practice without the AMBER bundle being formally used. Throughout 3 audit cycles there was a steady increase in ACP. Future planned interventions include appointing a frailty nurse to @home team to further embed AMBER@Home, distributing lanyard cards more often and using “Coordinate My Care” to improve accessibility to ACP decisions including PEACE.
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