Patients can become significantly deconditioned due to extended stays in emergency departments and acute medical unites. we need to 'turn off the tap' by improving collaborations between wards and community services."
B1. Ensure standardised assessment tools are implemented across the hospital in every ward
This can be achieved by:
- Initial ward assessment: Integrate a functional, mobility and optimal handed care risk assessment into the initial ward assessment carried out by the ward nurse in conjunction with occupational therapists or physiotherapists with optimal handed care as default. Ensure the resulting mobility and optimal handed care needs are included in people’s care plans and updated in medical records.
- Comprehensive assessment tool: Use the risk assessment tool to assess mobility (e.g., gait, balance, strength, range of motion), function (activities of daily living) and optimal handed care risk factors (e.g., patient weight, level of cooperation, specific needs). Establish clear, objective criteria for each element of the assessment, ensuring consistent interpretation by different staff members.
- Personalised care plans: Jointly develop personalised care plans during initial ward assessment with people, carers and families. Encourage people to select daily activities supported by moving and handling equipment, where necessary and track progress, fostering autonomy and responsibility.
- Triage-based approach: Implement a tiered system. Everyone receives a brief initial screen (e.g., "Can you walk independently?"). Those who screen positive (e.g., report difficulty walking, recent falls) proceed to a more comprehensive assessment by occupational therapists.
B2. Ensure ward staff working across the hospital have the necessary training and support to undertake initial function, mobility and moving and handling assessments.
Mandatory training on moving and handling is currently limited to two hours, and that isn't enough to change behaviour. Staff lack confidence, and the hierarchical structure in hospitals makes it hard for nurses to act autonomously."
This can be achieved by implementing:
- Comprehensive training programme: Provide comprehensive training to all relevant staff members (e.g., nurses, healthcare assistants, physiotherapists) on how to perform moving & handling assessments, use equipment, implement safe handling techniques and an understanding of different risks in hospitals and community. Educate staff on cultural differences that may influence a person's willingness to request or accept assistance. Ensure moving and handling practitioners in the hospitals are up-to-date with new training techniques and have access to appropriate equipment.
- Motivational interviewing training for staff: Equip staff with techniques to understand people’s values, goals, hopes and dreams, and to guide them towards behaviour change. This involves asking open-ended questions, affirming their strengths, reflective listening and encouragement, and summarising key points to foster people and carer buy-in to making changes.
- Competency assessments and continuous education: Conduct regular competency assessments to ensure that staff are proficient in performing assessments and using equipment safely, supported by continuous education opportunities to keep staff up to date with required skills.
- Simulation training: Use simulation training to provide staff with hands-on practice in assessing and managing people with diverse mobility and moving & handling needs.
- "Train the Trainer" programmes: Develop internal experts who can train and mentor other staff members to embed optimal handed care practices across the hospital and mitigate against staff turnover.
- Awareness of people’s wishes and choices: Educate and train staff to ensure people’s wishes are respected in line with their mobility and moving and handling assessment. Provide assurance that care will be taken to ensure their mobility is maintained throughout their stay in the hospital.
- Person empowerment: Train staff to effectively empower people to actively participate in their assessment and care plan by explaining the benefits of staying active and consequences of not moving during their stay in the hospital. Communicate to people that they should consider the hospital as an active zone and explain how they can contribute to achieving their goals.
For further details, see High Impact Change Area C, Empowering patients / carers.
B3. Ensure that the use of digital technology is optimised to reduce staff workload, improve communication between different staff groups and enhance people safety.
This can be achieved through:
- Electronic Patient Records (EPR): Integrate the assessment tool into the EPR system to allow for easy access, documentation, seamless information sharing between staff and data analysis.
- Alerts and reminders: Implement alerts and reminders within the EPR to prompt staff to conduct mobility and moving and handling assessments upon admission and at regular intervals during a person's stay in the hospital.
- Mobile technology: Utilise mobile devices (e.g., tablets) to allow staff to conduct assessments at the bedside, improving efficiency and accessibility.