Transcript Opening doors, improving lives

Opening Doors – Improving lives
Jo Fitzpatrick
Project Manager
15.11.11
www.qni.org.uk
Background of the project
Follows on from Homeless Health Initiative
Homeless families and homeless people with
focus on substance misuse
Aim: to improve health, care and experience
for the client
www.qni.org.uk
How aims will be
achieved
Network of nurses and health professionals
working with this client group
Monthly newsletter
Workshops
Practical guidance notes
Case studies of new working practices
Dissemination of best practice
www.qni.org.uk
Progress so far:
Newsletters – monthly e-newsletter
Q&A
‘Focus on’
Project news
General news articles
Resources – new documents, training
opportunities etc
www.qni.org.uk
Q&A:
Questions have been diverse:
 Students looking for placements
 Sources of information on international homelessness
 Job descriptions and service specifications
 IVDU’s and leg ulcers research
 Issues around clients with no recourse to public funds
 How to increase uptake of BBV services
 Hospital discharge
 A10 community increases and issues
 Community care grants for families
 Electronic patient records
This allows people to exchange information, gain help or advice and swap
stories. Also posted up on the website.
www.qni.org.uk
Progress so far:
Workshops 2011:
London – From the Cradle to the Grave
Newcastle – linking statutory and voluntary
agencies in the North East
TB master class
Workshop on Criminal Justice and MCA
2012- Birmingham – Safeguarding (March)
Manchester – Mental Health (June)
www.qni.org.uk
Workshops:
“Sharing what I’ve learnt
today with my team to
influence the way we work
with substance misuse
clients”
‘will make a difference gave
me a boost. Always loved
this work but today has
reactivated my enthusiasm
and given me lots of ideas
for further reading and
discussion with colleagues’.
‘to be realists and
listen to what the
service user wants.
Be positive no matter
how small the
change, be realistic
and don't give up’
“I will work with (various
partners) to implement
Hepatitis B vaccination
in all babies born to
mothers with substance
misuse issues”
www.qni.org.uk
Progress so far:
2011:
Safeguarding homeless families
Nutrition toolkit
2012:
Mental health
All toolkits aim to give basic information along
with practical tools and information to
improve service user health and wellbeing
www.qni.org.uk
What nurses said:
 It is very comprehensive and has pulled together a number of
strands, some of which I was already aware of, in a clear and
easy to use format for practice, so that my assessment is also
as comprehensive as it can be.
 I always find the information and guidance produced by QNI
to be helpful to improve practice and of a very high standard
(whilst being very 'user friendly' and easy to digest)
 ‘I am going to be moving to another trust at the end of the
week and I will be taking it with me. I am a Health Visitor
who will be working with very vulnerable families and I feel
this model will work extremely well in the assessment
process’
www.qni.org.uk
Outcomes from year 1:
• New Hepatitis C clinics for pregnant
women/blood borne virus testing resulting in
improved uptake
• New Nurse Liaison role developed at Newcastle
Royal Victoria Infirmary
• Specialised podiatry services for homeless and
vulnerably housed people developed
• On site flu vaccinations developed
www.qni.org.uk
Outcomes from year 1:
• Input into reports and consultations, including
NICE and Department of Health
• 77% of network members report improved
knowledge and practice
• 89% of network members reported that the
information from the project and newsletter
was very useful
• Network growth of over 100 – now 693
IVDU and leg ulcers – the
issues
•
•
•
•
•
I see approx. 12 individuals per who have existing or past leg ulcers as a result of IVDU- in the
4 customers I have on the books presently they have an average of 4 attendances per year to
A&E due to leg ulcers in the 12 months prior to being taken onto my case load. Since being
on the caseload 2 of them have had 1 admission each both of which were on my advice. All
of the customers with leg ulcers are between 25-35; 3 male 1 female and have had ulcer for
3-7 years
Individuals lead very chaotic lifestyles and as such find it difficult to keep to appointments
for dressings etc. one way I have found to address this is by holding “drop-in” clinics either at
the hostels or the “soup kitchens”- often I will txt message patients to remind them to come
and see me. I have also discussed with drug services as to holding sessions at their premises
when patients attend for methadone scripts, unfortunately I do not have capacity for this.
Pain control is very difficult as there is often a tolerance to opioid medication, there is often
a very low pain threshold. If someone is on testing through drug services they have to be
notified as some medications will give false positives which can cause issues if they are on
probation.
Due to chaotic lifestyles prescribing can cause problems they will forget to bring their
dressings with them – so I tend to store dressings myself
There is often poor compliance with antibiotics etc again I resort to txt msg reminders
www.qni.org.uk
IVDU and leg ulcers – the
issues
•
•
Stigma. This is a huge issue, much of my work surrounds gaining the trust of individuals.
Many have had previous poor experience in encounters with health care providers. There are
many reasons for this – poor compliance, view that damage is “self –inflicted” criminal
records h/o violence ex-offenders all of which serve to increase stigma and reduce rate of
engagement with services. The attitudes of some health care staff can be very paternalistic
and derogatory towards this disenfranchised group which causes them to disengage from
services
Lack of continuity of care- this is a very mobile group of individuals – therefore outpatient
appoints can be lost, may move addresses frequently. They may receive a custodial sentence.
If I do find out where they are serving their sentence I have tried to fax care plans etc to
prison health care services. Unfortunately it does not appear that there is much expertise in
wound care management especially compression therapy within prison services. As I have
received some incorrectly applied dressings back into the hostels on release from prison.
www.qni.org.uk
[email protected]
020 7549 1402
www.qni.org.uk