Forensic patient health improvement record

Secure mental health units at Rowanbank Clinic and Leverndale Hospital developed a comprehensive record to capture information on adult patients’ physical health and wellbeing.

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How it started

Patients in forensic services often face barriers to health improvement. These include weight management issues, smoking, restrictions on physical activity and side effects of medication. Information about patient health, such as the numbers of patients with diabetes, can be inconsistent and difficult to gather. To address these issues, the Forensic Health Improvement and Equalities Group decided to introduce the Patient Health Improvement Record (PHIR). The PHIR will allow the units to set benchmarks, to support service planning, and help individuals to set their own achievable health improvement priorities.

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Partners

  • Forensic Health Improvement and Equalities Group
  • nursing staff, including community psychiatric nurse
  • NHS Greater Glasgow and Clyde Public Health Resource Unit research and evaluation team
  • head occupational therapist
  • pharmacist
  • dietician
  • speech and language therapist
  • 50 male patients at Leverndale Hospital
  • 60 male and female patients in Rowanbank Clinic.

Process

A researcher helped to design the 50 page PHIR. The record includes tick box options and space for comments from staff and patients. A traffic light scoring system is used to highlight immediate problems and longer term issues. It also provides for different scenarios, as a patient’s capabilities may vary depending on their mental state. They may be relatively independent, may require prompting or supervision, or may be unable to complete the health record themselves. The health record collects detailed information on:

  • demographics
  • general health
  • biological family history (if known)
  • diet
  • physical activity
  • smoking
  • sexual health
  • mental health and wellbeing
  • speech and language
  • activities for daily living
  • employability
  • preparedness for discharge.

Key workers will complete the PHIR of one or two of their patients by gathering relevant information, such as occupational therapy assessments. They will choose appropriate times to get the patient’s input, taking account of individual issues such as a short attention span. The PHIR must be completed in 4-6 weeks to give a snapshot of the individual’s current health and wellbeing. The PHIR will follow patients after they have been discharged or transferred so that health improvement work can continue once they’ve left the care of the secure units. It will be reviewed every few months.

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Outcomes

The PHIR will help key workers to:

  • learn more about individual patients’ preferences, perceptions and likely motivation to improve their health
  • encourage patients to set their own tailored and realistic health improvement agenda
  • give health advice
  • monitor the side effects of medication
  • spot links and patterns, including family health history
  • encourage patients to anticipate health-related problems on discharge, such as the cost of smoking.

The PHIR data will help forensic service managers to make informed decisions about resource allocation, identify demographic issues and develop appropriate support for patients. Cross-service data will also help specialists such as speech and language therapists, who only see extreme cases, get a picture of wider prevalence.

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Evaluation

Feedback from the pilot was very positive. Both staff and patients could see the merits of the PHIR and were not put off by the process. The project’s researcher will build a database using individual records and will report their initial findings in 2013.

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Lessons learned

Some personal information can be difficult to obtain, especially where patients are disconnected from their families, but patients and staff were able to discuss many areas of health openly and in detail.

What’s next for the project?

In the wake of the pilot, the group plans to roll out the PHIR in the two secure mental health units at Rowanbank Clinic and Leverndale Hospital.

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Related documents and links

For a copy of the PHIR or a PowerPoint introduction to the PHIR, email: susan.fleming@ggc.scot.nhs.uk.

Contact

Tommy Harrison
Senior charge nurse
Directorate of forensic mental health and learning disabilities
Pine Ward
Rowanbank Clinic
133c Balornock Road
Glasgow
G21 3UL

Tel: 0141 232 6483
Email: ThomasEdward.Harrison@ggc.scot.nhs.uk

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