Patient and family involvement is a national priority in both mental health services and in the wider NHS. Our team were concerned about serious incidents where service users died by suicide whilst in or recently discharged from our mental health services. In 19% of cases we found that poor communication between mental health services and the patient’s family was a contributory factor.
This project set out to explore why this was and to increase families’ involvement in patient care.
We created a multi-disciplinary core project team. This comprised: Suicide Prevention Lead, Investigation & Learning Lead and a Quality Improvement Advisor.
In addition, we invited representatives from the Somerset Suicide Bereavement Support Service, and representatives from each mental health area to attend workshops/meetings and lead the improvement work in their area.
We adopted the trust ‘7 steps of improvement’ quality improvement methodology which incorporates Plan, Do, Study, Act (PDSA) cycles. In addition, we created a stakeholder plan to ensure that we were involving and communicating with our stakeholders.
Understanding the problem
After establishing the team, we wanted to understand our problem. To do this, we conducted a ‘problem understanding workshop’ where we used feedback from patients, families and carers to help us.
The next step was to agree the project aim and measures with our stakeholders. Our measures were:
• Outcome measure: no of unexpected deaths where communication between services and the family is likely to have contributed
• Process measure: no of teams/wards testing a change idea
• Balancing measure: family, carers and staff stories
Change ideas and PDSA cycles
We then conducted a workshop with staff to generate change ideas. We had a lot of ideas at the start, and 7 ideas were developed and tested for approximately 100 days. The ideas were:
• Inviting families/carers to discuss escalation plans prior to discharge
• Rechecking consent at patient assessments
• Asking family/carer contact details at triage
• Safety plans developed & process agreed with young person & other key people
• Adding suicide ideation to risk assessment in Memory Assessment Service
• Family involvement & name of carer/family added to care planning leaflet
• Exploring consent with patients
Each idea was tested on a small scale and the learning recorded. Important findings and recommendations from the PDSA cycles were:
• The language and tone used when talking and asking about consent mattered
• Ask for consent at first contact & check regularly - relationships change over time
• Use consent wisely and fully, for example by sharing safety plans and escalation plans
• Understand the barriers with empathy & curiosity and explore what they may be happy for you to discuss and what they are not
Sustainability & Spread
The project was shared in staff communications and at Safety and Suicide Prevention meetings. A celebration and learning event was held at the end of the project, to celebrate the project successes and capture the learning. One colleague was nominated for an award as recognition for their work on the project. Each team put together a package about their idea and their learning so that other teams could learn from them and apply the ideas.
Somerset NHS Foundation Trust (SFT) provides acute, community and mental health services. Follow our twitter account: @improvementmph