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Bevan Exemplar Cohort 7 Projects

Patients who ‘Walk with Purpose’: Developing clinical guidance

Sophia Keene

Betsi Cadwaladr University Health Board

The Safe Clean Care campaign during COVID19 pandemic within Betsi Cadwaladr University Health Board (BCUHB) identified that patients who walk with purpose (WWP) could be increasing the spread of infection across acute inpatient wards as well as community hospitals and Mental Health and Learning Disability (MHLD) wards.

Patients who walk with purpose may have dementia, delirium, alcohol withdrawal or a learning disability. They therefore may move around the environment more and not be as aware of social distancing and use of PPE.

Clinical conversations were planned with staff across the health board using the COM-B methodology which is a psychological approach to behaviour change. This was used to identify what was needed to support staff, patients and carers to reduce infection risk and improve patient centred care as well as support staff through escalation.

Project Aims/Objectives:

  • Clinical conversations using the COM-B methodology with staff in the East area of BCUHB, Central, West and MHLD including inpatient staff and community hospital staff of all grades
  • Identify themes across the areas and wards and invite all who took part to a task and finish group
  • Use themes and guidance already in place to develop a specific document to support patients, staff, unpaid carers and also reduce infection spread
  • Analyse what behaviour changes are needed in order to carry out any guidance

Project Outcomes:

A clinical guidance was developed (figure 1). This used prompts for staff to utilise in supporting patients but also involving families and carers, knowing who to involve and when and also when to escalate and ask for extra support. The guidance was made available with hyperlinks to the intranet for the most up to date referrals to specialists and also to important documents such as the mental capacity act and policy on alcohol withdrawal.

Figure 1.

Project Impact:

The guidance was trialled on eight wards (two in each area) and a feedback questionnaire was developed using the COM-B headings as sections. There were 25 questions in total. This was sent to the wards for them to complete as a group (one per ward or area) (see figure 2)

Figure 2.

Key Conclusions:

The feedback was qualitative data which was thematically analysed using the COM-B Methodology (Figure 3). Wards had been displaying the guidance in a paper format and found this more useful however they had disseminated it electronically via email or whatsapp groups for their ward staff. Discussion of the guidance was being used at safety briefs and ward rounds, managing WWP as an MDT approach. Bank and agency staff were using the guidance and found it particularly helpful. The interactive links were good and wards felt they had good links with IPC and Psychiatric liaison already. Most wards found that the guidance was very busy and ‘wordy’ and they had not had enough time to fully utilise the guidance. Some areas found it difficult with competing demands of the ward and felt the guidance may fit better in a ward with less patients who WWP. Care of the elderly wards and dementia wards for example felt they were already doing everything from the guidance.

Figure 3.

View the project poster and slides from the Cohort 7 Exemplar Showcase