UUsing Care Bundles

Steve Kingsbury and Ann York

Habit

Handle Demand

Extend capacity.

Let go of families.

Process map and redesign.

Flow management.

Use Care Bundles.

Look after staff.

Average

43%

40%

30%

30%

38%

8%

68%

Data from 100 teams in 2005 Average total score 38% (42/111)

Remember…artificial variation

Natural variation Users are different We are different

Artificial variation How we do things

Research shows that artificialvariation has greatest impact onservices!

Use Care Bundles

Links to High Impact Changes number 6:

‘increase reliability of interventions by designing care based on: what is known to work

and

that service users and carers inform and influence’

Care Bundles

Manage complex problems Reduce variation in practice Aim to ensure everyone receives the best

care Defines what you do Draws on evidence, expert view and user

views Easy to monitor compliance

Table discussion A

What problems could you develop care bundles for?

Developing a Care Bundle1. Know current best practice

Decide what you are going to develop a Bundle on!

Something where a combination of approaches are needed

Find evidence e.g. NICE, Drawing on the Evidence

Developing a Care Bundle 2. Local best practice

Evidence from research may not be available!

Discuss and reach consensus Ask users what works

Developing a Care Bundle 3: Implement and monitor

Quick checklist in file Monitor frequently

e.g.Surgical site infection Bundle

Appropriate antibiotic prophylaxisControl of blood glucoseUse of ‘clipping' not shavingMaintain core temperature above 36.6 C

Developing a Care Bundle for Anorexia Nervosa in Richmond CAMHS

Eating Disorders team gathered evidence Asked users what helped Agreed together what needed to be done

at assessment and by whom Agreed package of interventions Agreed monitoring Wrote up Have a bundle implementation plan

Richmond Anorexia nervosa bundle (1)

AssessmentChoice appointment unless BMI under 15 Multi-disciplinary assessment within 2 weeks

Systemic Dietetic Psychiatric Physical EDE

Richmond Anorexia nervosa bundle (2)

Intervention with 3 monthly reviews Physical care Family therapy Psychiatric Multifamily groups Individual Dietetic

School refusal bundle development in E Herts.

Process Did a team role play to explore various

experiences Formed a working group Met and written a draft pathway and bundle Planning initial meeting with EWO

management to understand their process After that will have multi-agency workshop to

consider plan Forgotten user input!

Table discussion B

Go back to your suggestions

Pick one and devise a Bundle for one of them…

Who, what, where, when…