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Wellbeing Wednesdays: nurse-led clinic for improving physical health care in a general adolescent inpatient unit

27 February 2020
Professional
02 February 2020
Volume 29 · Issue 4

Abstract

Background:

Young people with mental illness are at high risk of physical health complications. Physical healthcare on a general adolescent inpatient unit is complex.

Aim:

To establish a wellbeing clinic to improve efficiency and quality of the physical healthcare offered and increase health promotion.

Methods:

Plan, Do, Study, Act (PDSA) cycles were used to drive this quality-improvement project. The authors audited 12 records before establishing the clinic and 12 at three further time points (6, 18 and 30 months post-intervention) to guide changes.

Results:

Results progressively improved over PDSA cycles. Time taken for initial investigations dropped. Compliance with medication monitoring and management of important physical health domains rose from zero in some cases to 100% in all but one area.

Conclusions:

Establishing a dedicated physical health clinic in this setting is feasible and leads to improved performance against local and national standards. Mental health teams need to ensure physical health is prioritised.

On a general adolescent inpatient unit for young people with mental health difficulties (including anorexia nervosa and affective, anxiety and psychotic disorders), staff and patients identified room for improvement in physical healthcare provision. Until this point, physical health reviews and investigations were done on an ad hoc basis.

The Trust's physical health policy and relevant national guidance lists a wide range of factors to be covered, including lifestyle risk factors, pre-existing health conditions, screening, medication management and health promotion (Shiers et al, 2014; NHS England, 2014; Royal College of Psychiatrists, 2015; Department of Health (DH) and Public Health England (PHE), 2015; National Institute for Health and Care Excellence (NICE), 2016; DH and PHE, 2016; NICE, 2017). It was difficult to keep track of each person's care. Feedback from the patients indicated they wanted a planned approach to appointments and access to information on healthy living topics.

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Mental health inpatient services
Adolescent mental health services
Nurse-led clinic
Service improvement
Health promotion