#WeLDNs - Tuesday 19th November 2019 8:30pm (GMT Standard Time) Factors affecting readmission into mental health hospitals

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Hosted by WeLDnurses using #WeLDNs

This chat is guest hosted by @LiamFreeman1991

On Tuesday 19thNovember join us at 20:30 via @WeLDNurses using #WeLDNs to chat about the factors affecting readmission for a person with learning disabilities and autism onto a mental health unit. 

For this chat our student intern Liam (@LiamFreeman1991) is taking on the role as guest host to chat about a topic which he is interested in from exposure through placement. 

“The reason behind this chat is from personal experience, where I supported a gentleman who had a diagnosis of learning disability and autism whilst he was staying in an Assessment and Treatment Unit (ATU) when I was on placement. During the time of doing my studies I heard he was being discharged and his transition was happening to prepare him to be living in community. However, after only being discharged into a community placement for around 6 months, he had been readmitted back into ATU. Which got me thinking, what were the factors that caused this readmission?"

Between the months of January 2019 to July 2019 in the UK, there was on average 109 (765, all together) people with learning disability/autism admitted onto a mental health ward. For readmission, it was on average of 22 per month (155, all together) that were readmitted within a year of being discharged (National Health Service Digital- Learning Disability Services Monthly Statistics, 2019). 

We are keen to generate a dialogue which discusses factors affecting readmission, predicting readmission and support post discharge from a mental health hospital setting. 

Join us to discuss factors affecting readmission, share your experiences, knowledge and evidence base around processes already in place.

References and further reading

National Health Service Digital (2019) Learning Disability Services Statistics

The detention of young people with learning disabilities and/or autism (2019), House of Commons and House of Lords; Joint Committee on Human Rights. 

Transforming Care (2017), NHS England 

Care services for people with learning disabilities and challenging behaviour (2015), National Audit Office. 





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 Chat Summary

 

On Tuesday 19thNovember @WeLDNurses hosted a chat on the factors affecting readmission for a person with learning disabilities and autism onto a mental health unit using #WeLDNs.

We were joined by a range of healthcare professionals and student nurses who had a variety of experiences and knowledge. 

To help us understand admission statistics @chrishattoncedr compiled a graph using data from the Assuring Transformation dataset.  It showed that between Oct 18 to Sept 19 there was 2,250 admissions into AT, out of them 90 were readmitted in 30 days and 155 were readmitted within a year of leaving an inpatient unit. It is important to note however that data on readmission is limited and doesn’t highlight specific circumstances.

During the chat there was discussion on the Green light framework used in the north east that is a self-audit tool with the aim to improving the mental health support services for people with learning disability. Participants were able to educate and advise each other on various frameworks used across the rest of the UK.

Recurring themes emerging throughout the chat included readmission being due to the individual feeling safer within an inpatient unit, breakdown within placements, issues with funding and the role of the nurse.

These themes led to further discussion around the need for correct, personalised support to ensure these individuals feel safe in community, therefore potentially reducing the need for readmission. “Right place for the right person” was a phrase that cropped up surrounding breakdown of placements. Similarly, it is important to build a stable and supportive care plan ready for the individual when they are discharged into the community. This care plan should follow holistic principles and cover everything from communication needs to implementing positive behaviour support. Nurses should be establishing effective transition ensuring that new staff are educated on the individual and able to recognise possible relapse indicators so the correct support and intervention can be put in place in a timely fashion to reduce the chance of unnecessary readmission.

There were other issues highlighted that could have an impact on appropriate placements for an individual with learning disabilities. These could be funding, the reduction of budgets and management. It was also highlighted that whilst some may argue that a bespoke placement may be more expensive compared to other placements, in the long run it could be more cost effective due to the correct support being in place leading to reduction in unnecessary readmissions to mental health units. 

This chat created important discussion around such a vital topic, one that will be ongoing and evolve over time. Participants shared key messages and themes that they would take away from the chat into their practice.

A big thank you to our student intern @LiamFreeman1991 for championing this topic and helping to curate the chat. 





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 #WeLDNs transcript

 
@WeLDnurses
19 November 2019 20:30
Good evening everyone and welcome to tonight’s chat! For this chat our student intern @LiamFreeman1991 is acting as guest host! Let’s have a round of hellos ???? #WeLDNs
@LiamFreeman1991
19 November 2019 20:30
@WeLDnurses Hello, everyone #weldns
@paularich1977
19 November 2019 20:31
@WeLDnurses @LiamFreeman1991 Hey everyone from South Wales. #weldns
@LucyAnn_Spencer
19 November 2019 20:31
@WeLDnurses @LiamFreeman1991 Hello, Lucy here :) #WeLDNs
@WeLDnurses
19 November 2019 20:31
@paularich1977 @LiamFreeman1991 Evening @paularich1977! #WeLDNs
@CommunityLd
19 November 2019 20:31
@WeLDnurses @LiamFreeman1991 Hey Glenn from County Durham #weldns
@lynnewalsall
19 November 2019 20:31
#EBP #WeLDNs Evening everyone Lynne here in Walsall #waving
@WeLDnurses
19 November 2019 20:32
@LucyAnn_Spencer @LiamFreeman1991 Hi @LucyAnn_Spencer :) #WeLDNs
@HabitualJoshing
19 November 2019 20:32
Evening! Josh here over in Staffordshire #WeLDNs
@WeLDnurses
19 November 2019 20:32
@CommunityLd @LiamFreeman1991 Great to have you with us Glenn! #WeLDNs
@zoeeuk
19 November 2019 20:32
@WeLDnurses @LiamFreeman1991 Hey!! Multi tasking here but looking forward to tonight's chat ?? #weldns
@WeLDnurses
19 November 2019 20:32
@lynnewalsall Evening @lynnewalsall ! Thanks for joining us! #WeLDNs
@Cathy_55555
19 November 2019 20:33
@WeLDnurses @LiamFreeman1991 Hello all. Catherine here to dip in and out of the chat. #weLDNs
@WeLDnurses
19 November 2019 20:33
@HabitualJoshing Good evening @HabitualJoshing! #WeLDNs
@Edge_mo
19 November 2019 20:33
@WeLDnurses @LiamFreeman1991 Hello everyone! #WeLDNs
@WeLDnurses
19 November 2019 20:33
@zoeeuk @LiamFreeman1991 Got to love a bit of multitasking! Very skilled @zoeeuk #WeLDNs
@WeLDnurses
19 November 2019 20:33
@Cathy_55555 @LiamFreeman1991 We love a lurker! Great to have you with us #WeLDNs
@lynnewalsall
19 November 2019 20:33
#weldns #EBP hello Liam @wlv_health https://twitter.com/WeLDnurses/status/1196888414173437959
@WeLDnurses
19 November 2019 20:34
@Edge_mo @LiamFreeman1991 Evening! #WeLDNs
@salsa442
19 November 2019 20:34
Hi all, late and lurking but I’m here #WeLDNs
@WeLDnurses
19 November 2019 20:35
@salsa442 You know we love a lurker Sal! Be as noisy as you want #WeLDNs
@WeLDnurses
19 November 2019 20:35
Don’t forget to use #WeLDNs in all of your tweets tonight so we don’t miss any of your wonderful responses!
@WeLDnurses
19 November 2019 20:35
Let’s get started!! What are your experiences with readmission into a mental health unit for an individual with a diagnosis of learning disabilities or autism? #WeLDNs
@salsa442
19 November 2019 20:35
@WeLDnurses Obvs I’m a noisy lurker ?? #WeLDNs
@WelchySquelchy
19 November 2019 20:35
@WeLDnurses @LiamFreeman1991 good evening am also multitasking and lurking #weldns
@WeLDnurses
19 November 2019 20:36
@WelchySquelchy @LiamFreeman1991 Great to have you with us! #WeLDNs
@CommunityLd
19 November 2019 20:36
@WeLDnurses For clarity are we talking about acute mental health wards under green light process? #weldns
@LucyAnn_Spencer
19 November 2019 20:36
@WeLDnurses No experience here. Looking forward to hearing others share their experiences #weldns
@salsa442
19 November 2019 20:37
RT @WeLDnurses: Don’t forget to use #WeLDNs in all of your tweets tonight so we don’t miss any of your wonderful responses!
@LiamFreeman1991
19 November 2019 20:37
RT @WeLDnurses: Don’t forget to use #WeLDNs in all of your tweets tonight so we don’t miss any of your wonderful responses!
@Cathy_55555
19 November 2019 20:37
@WeLDnurses Having witnessed this on a few occasions, I generally feel it has had a negative impact on their MH often increasing the initial issue they suffered with #weLDNs
@salsa442
19 November 2019 20:37
@LucyAnn_Spencer @WeLDnurses I’ve got very limited experience of this, and it was many years ago so I’m hoping to learn a few things tonight #WeLDNs
@LiamoJC
19 November 2019 20:38
Lurking in the background An older Liam from ????#WeLDNs
@LiamFreeman1991
19 November 2019 20:38
@CommunityLd @WeLDnurses What's a green light process? #weldns
@linzisueboo
19 November 2019 20:38
@WeLDnurses I have seen a number of people who have remained in the community since discharge. Sadly, placement breakdowns have also happened & there are providers who assess someone when they are settled but then are unable to manage when someone is in distress #WeLDNs
@salsa442
19 November 2019 20:39
Many years ago I felt there were a lot of people who repeatedly got re-admitted, is this still something that happens? #WeLDNs https://twitter.com/weldnurses/status/1196889781302702087
@CommunityLd
19 November 2019 20:39
@LiamFreeman1991 @WeLDnurses Green light is an admission framework when people with a learning disability are admitted to mental health services #weldns
@paularich1977
19 November 2019 20:40
@WeLDnurses My experience is quite limited, but I am of an individual who it seemed sought readmission to an assessment and treatment unit because they enjoyed the social aspect of mixing with other patients away from their normal family setting, not sure if this is common though #weldns
@zoeeuk
19 November 2019 20:40
@WeLDnurses I have only just recently began in a role where this is something that we may come across, however as a student I've noticed the impact which is a negative experience for those involved #weldns
@LucyAnn_Spencer
19 November 2019 20:40
@linzisueboo @WeLDnurses Very good point @linzisueboo #weLDNs
@WeLDnurses
19 November 2019 20:40
Here’s some #EBP from the Assuring Transformation dataset put together by @chrishattoncedr detailing admission numbers to inpatient units #WeLDNs https://t.co/rCQxhDpuRD
@CommunityLd
19 November 2019 20:40
@LiamFreeman1991 @WeLDnurses https://www.mentalhealth.org.uk/learning-disabilities/publications/green-light-mental-health #weldns #ebp
@HabitualJoshing
19 November 2019 20:41
@WeLDnurses I can’t think of many individuals I’ve supported who have been readmitted, but subsequent breakdowns in support have occured, sometimes requiring a change in provision #weldns
@WeLDnurses
19 November 2019 20:41
RT @CommunityLd: @LiamFreeman1991 @WeLDnurses https://www.mentalhealth.org.uk/learning-disabilities/publications/green-light-mental-health #weldns #ebp
@linzisueboo
19 November 2019 20:41
@WeLDnurses In my experience many people have gone to ATUs after a placement breakdown, they then get discharged to a new home & team. Another placement breakdown can lead to very poor self esteem & impact mental health #WeLDNs
@Cathy_55555
19 November 2019 20:41
@linzisueboo @WeLDnurses Very difficult. It comes down to funding I believe and therefore gaps in care are not bridged causing a dip in mental health problems all too often #weLDNs
@salsa442
19 November 2019 20:41
@paularich1977 @WeLDnurses Years ago I worked with someone who openly said they would try to get readmitted as it felt ‘safer’ in hospital ?? #WeLDNs
@lynnewalsall
19 November 2019 20:42
@salsa442 #weldns #ebp getting things completed first time should be our aim. If this means discharging people takes longer then surely this is better than re-admission.
@LiamoJC
19 November 2019 20:42
Discharge planning is crucial to ensure the discharge plan reflects the needs for supports to prevent relapse especially around adherance to a medication regime #WeLDNs
@LiamFreeman1991
19 November 2019 20:42
@CommunityLd @WeLDnurses That is quite interesting, I never thought of that, I was thinking of care treatment order or guardianship #weldns
@paularich1977
19 November 2019 20:42
@salsa442 @WeLDnurses I’ve heard similar stories Sal #weldns
@WeLDnurses
19 November 2019 20:42
Thanks for sharing @salsa442 #WeLDNs https://twitter.com/salsa442/status/1196891281454227457
@CommunityLd
19 November 2019 20:43
@LiamFreeman1991 @WeLDnurses It’s well established in areas of the north east but isn’t without its issues eg skilled staffing #weldns
@linzisueboo
19 November 2019 20:43
@Cathy_55555 @WeLDnurses Many councils want to save money as they have had funding cut. You need to really prove they need the level of staffing & care you are suggesting. If they are settled in ATU, it can be seen as previous issues being solved. #WeLDNs
@salsa442
19 November 2019 20:43
@WeLDnurses @chrishattoncedr I have to say there are fewer readmissions there then I expected. But still a lot, I’m interested to know are the transfers from other hospitals from acute general? There seem to be growing numbers of MH crisis in our Emergency Departments #WeLDNs
@salsa442
19 November 2019 20:43
RT @CommunityLd: @LiamFreeman1991 @WeLDnurses https://www.mentalhealth.org.uk/learning-disabilities/publications/green-light-mental-health #weldns #ebp
@WeLDnurses
19 November 2019 20:44
Q2. What do you think are some of the factors that affect readmission onto a mental health ward for someone who has learning disabilities or autism? #WeLDNs
@paularich1977
19 November 2019 20:44
@linzisueboo @WeLDnurses Christmas seems to be such a time for plenty of admissions, difficult time of year for a lot of our individuals #weldns
@Cathy_55555
19 November 2019 20:44
@WeLDnurses I also believe that at times carers or respite care is in shortfall and so often due to desperation people can be wrongly admitted #weLDNs
@LiamoJC
19 November 2019 20:44
#weldns https://twitter.com/LiamoJC/status/1196892026131767296
@salsa442
19 November 2019 20:45
@lynnewalsall I agree totally, sometimes the pressure for discharge means things aren’t done completely which surely increases risk of readmission? #WeLDNs
@LiamFreeman1991
19 November 2019 20:45
@CommunityLd @WeLDnurses I will have to give it a good read to get better understand of the pros and cons #weldns
@paularich1977
19 November 2019 20:45
@LiamoJC @salsa442 @WeLDnurses I would definitely say the prison service sadly provides a safe haven for lots of individuals #weldns
@Cathy_55555
19 November 2019 20:45
@linzisueboo @WeLDnurses Absolutely. Having worked on a respite unit and seeing the funding cut and threat of closure it is all too true sadly #weLDNs
@CommunityLd
19 November 2019 20:45
@WeLDnurses Reactive crisis services rather than seeking to build capacity in community. #weldns
@LucyAnn_Spencer
19 November 2019 20:46
@WeLDnurses I think @linzisueboo made a good point about people being assessed when they are settled but the providers are unable to manage when the person is in distress. #weLDNs
@lynnewalsall
19 November 2019 20:46
#weldns getting services which meet individual needs https://twitter.com/WeLDnurses/status/1196891927230193664
@zoeeuk
19 November 2019 20:46
@WeLDnurses Lack of appropriate replacement after discharge. Staff and services unequipped to support the person appropriately... this can be frustrating especially if there has been an in depth transition #weldns
@WelchySquelchy
19 November 2019 20:46
@WeLDnurses I have met people who just do not have the ongoing support or the incorrectly set up support to be able to maintain living at home and are readmitted #WeLDNs
@linzisueboo
19 November 2019 20:46
@Cathy_55555 @WeLDnurses There is often also a "honeymoon period" when someone goes to a new placement. This can make placement breakdown even more of a shock and make us wonder what went wrong? #WeLDNs
@salsa442
19 November 2019 20:46
@LiamoJC @paularich1977 @WeLDnurses So have I Liam, I guess the structured environment/boundaries/lack of choice is actually quite reassuring for some people- but this can surely be achieved in a less restrictive way #WeLDNs
@Shaun_LDNurse
19 November 2019 20:46
@WeLDnurses Sadly very little experience so far. I’ve seen individuals admitted (who have been previously inpatients) and people who have been discharged. #WeLDNs
@WeLDnurses
19 November 2019 20:46
Has anyone else heard of this framework/ know of other frameworks in their area of the world? #WeLDNs https://twitter.com/communityld/status/1196890833146056708
@Mermcm
19 November 2019 20:47
We have to be careful about what ‘population’ we are talking about here - people with LD/ASD who have spent time in ATUs who may get readmitted due to placement breakdown etc or people with diagnoses MH issues where the factors may be different #weldns https://twitter.com/WeLDnurses/status/1196891927230193664
@LiamoJC
19 November 2019 20:47
@salsa442 @paularich1977 @WeLDnurses The predictable routine and rare changes in it can be a welcome environment for someone with mental health difficulties and ASD in particular. #weldns
@paularich1977
19 November 2019 20:47
@salsa442 @lynnewalsall Agree completely, need to look at getting the right setting for the right person... particularly the mix with co-tenants being crucial to successful discharge #weldns
@LucyAnn_Spencer
19 November 2019 20:47
RT @WeLDnurses: Has anyone else heard of this framework/ know of other frameworks in their area of the world? #WeLDNs https://t.co/3ryMnhkz…
@HabitualJoshing
19 November 2019 20:47
@WeLDnurses The evidence-base suggests that while individual factors, such as deteriorating physical and mental health, may affect readmission, staff and organisational factors have a big impact #weldns
@linzisueboo
19 November 2019 20:48
@Cathy_55555 @WeLDnurses I have noticed over the years that where ATUs have been closed & the desire to keep people with LD & autism away from psychiatric hospitals, there has been a heavier reliance on respite units in many cases. Was this your experience? #WeLDNs
@Mermcm
19 November 2019 20:48
The GLTK is more of an audit tool than a framework but it does set out what AMH services should be doing to meet the needs of PwLD #weldns https://twitter.com/WeLDnurses/status/1196892626223583232
@WeLDnurses
19 November 2019 20:48
@salsa442 @chrishattoncedr The transfers are from another inpatient unit #WeLDNs
@WeLDnurses
19 November 2019 20:49
Really interesting point, has anyone else experienced this? #WeLDNs https://twitter.com/linzisueboo/status/1196892958643179522
@paularich1977
19 November 2019 20:49
@LiamoJC @salsa442 @WeLDnurses Also in services we still have a lot of patients that used to be in long stay hospitals, sadly still institutionalised... this structure and routine provides comfort for them and it is all they have known, trying to introduce change and choice proves very difficult #weldns
@salsa442
19 November 2019 20:49
@linzisueboo @Cathy_55555 @WeLDnurses I’ve seen this happen so often, it’s always sad when services can not cope with crisis behaviour, I think specialist commissioned LD services need to be responsive to MH crisis #WeLDNs
@linzisueboo
19 November 2019 20:49
@paularich1977 @WeLDnurses Oh definitely, I have noticed Xmas & New Year being a particularly vulnerable time of year for readmission to MH units. I think a mixture of being out of routine & it being a lonely time for many can lead to difficulties. #WeLDNs
@LiamFreeman1991
19 November 2019 20:50
RT @WeLDnurses: Has anyone else heard of this framework/ know of other frameworks in their area of the world? #WeLDNs https://t.co/3ryMnhkz…
@WeLDnurses
19 November 2019 20:50
RT @lynnewalsall: @salsa442 #weldns #ebp getting things completed first time should be our aim. If this means discharging people takes long…
@salsa442
19 November 2019 20:50
@LiamoJC @paularich1977 @WeLDnurses I can totally see that #WeLDNs
@Cathy_55555
19 November 2019 20:50
@WeLDnurses Lack of funding. Staff shortage. Carers not able to safely manage certain behaviours. It feels a little like we are 'instutionalising'. Very sad #weLDNs
@zoeeuk
19 November 2019 20:50
@linzisueboo @Cathy_55555 @WeLDnurses I've noticed that too @linzisueboo #weldns
@LiamoJC
19 November 2019 20:50
@paularich1977 @salsa442 @WeLDnurses And we can have institutionalised staff in services too that don't like change #weldns
@WeLDnurses
19 November 2019 20:50
RT @lynnewalsall: #weldns getting services which meet individual needs https://twitter.com/WeLDnurses/status/1196891927230193664
@CommunityLd
19 November 2019 20:51
@WeLDnurses Inconsistent application of the MHA by clinicians and a reluctance to admit patients or offer informal stay to prevent crisis #weldns
@HabitualJoshing
19 November 2019 20:51
@WeLDnurses The Green Light Toolkit is an England-wide Framework. Though I think organisational approaches to it across the country are variable #weldns
@paularich1977
19 November 2019 20:51
@LiamoJC @salsa442 @WeLDnurses Couldn’t agree more #weldns
@ross_6479_RNLD
19 November 2019 20:51
@WeLDnurses Lack of stable community support or breakdown of community provision/provider often a factor, transition plan not working effectively another ime sorry I’m late ?? #weldns
@salsa442
19 November 2019 20:51
@WeLDnurses @chrishattoncedr Thanks for the clarity - think I’ve been working in general hospitals too long! #WeLDNs
@linzisueboo
19 November 2019 20:51
@salsa442 @Cathy_55555 @WeLDnurses I work in a MHinLD team, we make sure that crisis and contingency plans are in place. We need to ensure that we know what the early warning signs are and how to act on them. Make sure that service user, carers & professionals all have a copy #WeLDNs
@WeLDnurses
19 November 2019 20:51
What is the role of the nurse in reducing readmission to a mental health ward for an individual with learning disabilities or autism? #WeLDNs
@Shaun_LDNurse
19 November 2019 20:52
@WeLDnurses * it’s important to note though, I am very much aware of the high profile reported cases concerning mental health, learning disability, and autism (including placement breakdown following time in ATUs) - which I am sure we are all aware of - #WeLDNs
@Mermcm
19 November 2019 20:52
Anecdatally I’ve always found summer a worse time for crisis than Xmas, families etc tend to pull together over the holidays but in summer when many profs are on hospital, and also the younger people are out of school/college can be a difficult time #weldns https://twitter.com/linzisueboo/status/1196893403704909829
@paularich1977
19 November 2019 20:52
@linzisueboo @WeLDnurses The good things about Christmas such as the build up of excitement and receiving of gifts can prove overwhelming also #weldns
@zoeeuk
19 November 2019 20:52
@linzisueboo @paularich1977 @WeLDnurses Especially since dah services are unavailable at the time and some people living in rural areas limiting their ability to access anything #weldns
@LiamFreeman1991
19 November 2019 20:52
@linzisueboo @Cathy_55555 @WeLDnurses I remember reading an article of how services would put bids in for service user, and the 'cheapest' was picked due budgets, but I can't fully quote on it #weldns
@CommunityLd
19 November 2019 20:52
@WeLDnurses Leading and planning consistent support for an individual to prevent readmission #weldns
@zoeeuk
19 November 2019 20:53
@linzisueboo @paularich1977 @WeLDnurses That should say the and not dah... didnt make up an acronym! #weldns
@salsa442
19 November 2019 20:53
@linzisueboo @Cathy_55555 @WeLDnurses That’s really interesting (and cool!) are you able to support third sector providers when their people have a MH crisis? Do you do training for them? #curiousnurse #WeLDNs
@WeLDnurses
19 November 2019 20:53
If staff and organisational factors have such a large impact what can we, as nurses, do to prevent unnecessary readmission? #WeLDNs https://twitter.com/habitualjoshing/status/1196892853609340928
@Cathy_55555
19 November 2019 20:53
@LiamFreeman1991 @linzisueboo @WeLDnurses Yes. Absolutely disgraceful. Imagine all the work Mansell did...and for what? Very sad #weLDNs
@WeLDnurses
19 November 2019 20:54
@paularich1977 @salsa442 @lynnewalsall This is a great point #WeLDNs
@Mermcm
19 November 2019 20:54
Ensuring people/carers are aware of triggers and relapse indicators, making sure there is a robust crisis & contingency plan, supporting people that *do* need admission through the process & discharge planning #weldns https://twitter.com/WeLDnurses/status/1196893867603365888
@linzisueboo
19 November 2019 20:54
@zoeeuk @Cathy_55555 @WeLDnurses I used to think of respite units as more short break centres, so carers can go on holiday etc. Now they seem to have taken on a role of supporting people in between placements. Some end up there for months whilst suitable placement is found #WeLDNs
@ross_6479_RNLD
19 November 2019 20:54
@WeLDnurses Involvement should start from pre discharge, supporting transition and helping build stable supportive care plans in the community, then helping implement and monitoring are just some #weldns
@lynnewalsall
19 November 2019 20:54
totally agree #weldns https://twitter.com/CommunityLd/status/1196894113217548298
@salsa442
19 November 2019 20:54
For me it’s about effective care planning, transition/familiarisation to new service and people and ensuring EWS are acted on straight away #WeLDNs https://twitter.com/weldnurses/status/1196893867603365888
@ross_6479_RNLD
19 November 2019 20:55
@WeLDnurses Strong collaborative MDT important too #WeLDNs
@HabitualJoshing
19 November 2019 20:55
@Mermcm Anecdotally I would agree; there are also those younger people who finish school or college and don’t have anything identified to move onto who may then require more input from specialist services #weldns
@CommunityLd
19 November 2019 20:55
@lynnewalsall If we have proactive teams that work with providers to scaffold placements. Rapid access to positive behaviour support, formulation, staff training and psychosocial interventions would be invaluable #weldns
@lynnewalsall
19 November 2019 20:55
RT @ross_6479_RNLD: @WeLDnurses Strong collaborative MDT important too #WeLDNs
@Mermcm
19 November 2019 20:56
That should say holiday not hospital! #weldns https://twitter.com/Mermcm/status/1196893972012158979
@zoeeuk
19 November 2019 20:56
@salsa442 100% and a explicit behaviour support plan! With training ideally! #weldns
@LiamFreeman1991
19 November 2019 20:56
@WeLDnurses Training the new staff of discharge Pw/LD importance of following care plans (Comms, PBS and etc.) As well as, seeing if the service provider will be able to support the individual. #weldns
@linzisueboo
19 November 2019 20:56
@salsa442 @Cathy_55555 @WeLDnurses We put in plans and support providers, we have done training but not in general MH. If a service user has a diagnosis we will tailor a session about that diagnosis and how it presents in that person & how to support. #WeLDNs
@LiamoJC
19 November 2019 20:56
I feel an effective keyworker system works well. Build a therapeutic relationship with Trust and effective Communication. I feel that helps prevent relapse? Keyworker can bridge inpatient to home transtion too #weldns
@paularich1977
19 November 2019 20:56
@WeLDnurses Network training on the individuals needs/wishes and their plans, effective transition planning, being a support for the individual as well as those supporting them #weldns
@WeLDnurses
19 November 2019 20:56
RT @zoeeuk: @salsa442 100% and a explicit behaviour support plan! With training ideally! #weldns
@salsa442
19 November 2019 20:56
@zoeeuk Definitely the behaviour support plan #WeLDNs
@Shaun_LDNurse
19 November 2019 20:57
@WeLDnurses Putting people back into a similar environment they were previously having little support in, where the support really isn’t up to scratch (whatever form that takes). #WeLDNs
@ross_6479_RNLD
19 November 2019 20:57
@WeLDnurses Listening to what is identified as best for the individual on discharge and making it person centred not service/availability centred #WeLDNs
@WeLDnurses
19 November 2019 20:57
RT @ross_6479_RNLD: @WeLDnurses Strong collaborative MDT important too #WeLDNs
@lynnewalsall
19 November 2019 20:57
#weldns so very true Josh Transition is vital https://twitter.com/HabitualJoshing/status/1196894871430336512
@LiamFreeman1991
19 November 2019 20:57
@Edge_mo @WeLDnurses So, this could be from nurse at the mental health ward/community nurse/residential nurse #weldns
@linzisueboo
19 November 2019 20:57
@paularich1977 @WeLDnurses Definitely, for some it's complete overload and then a come down afterwards. #WeLDNs
@WeLDnurses
19 November 2019 20:57
RT @CommunityLd: @WeLDnurses Leading and planning consistent support for an individual to prevent readmission #weldns
@Mermcm
19 November 2019 20:57
Support the providers, support the Commissioners - make use of the data and local knowledge #weldns https://twitter.com/WeLDnurses/status/1196894337315098626
@zoeeuk
19 November 2019 20:58
@ross_6479_RNLD @WeLDnurses Our team has a person centred lead who focuses on the Placement matrix and creates an ideal gold standard placement to work towards #weldns
@ross_6479_RNLD
19 November 2019 20:58
@zoeeuk @WeLDnurses This sounds great ?? #WeLDNs
@Mermcm
19 November 2019 20:59
That sounds an interesting role - would like to know more #weldns https://twitter.com/zoeeuk/status/1196895535971606528
@Shaun_LDNurse
19 November 2019 20:59
@WeLDnurses * really important to note #WeLDNs it’s not for want of trying either (quality and comprehensive support is scarce).
@linzisueboo
19 November 2019 20:59
@zoeeuk @paularich1977 @WeLDnurses Even in urban areas, many of the services close down for Xmas. Even one to one carers often call off sick over that period, which then throws people off. Even more difficult in rural areas, where people rely on services just to leave the house #WeLDNs
@LiamoJC
19 November 2019 20:59
Not sure if done in UK , but in-reach work by #rnld is crucial for effective d/c planning. Plus having knowledge of existing services in Community is NB to facilitate a realistic d/c plan #weldns
@zoeeuk
19 November 2019 21:00
@ross_6479_RNLD @WeLDnurses Granted when it comes to finding them it may be tricky but it doesnt stop anyone pushing for those placements! #weldns
@WeLDnurses
19 November 2019 21:00
Thanks for the clarification @LiamFreeman1991. How can a nurse (any branch) working with an individual with LD/ ASD best support them to reduce chances of readmission? #WeLDNs https://twitter.com/liamfreeman1991/status/1196895268362506241
@LucyAnn_Spencer
19 November 2019 21:01
@WeLDnurses as well as supporting the individual I think its important to support the provider and the staff team. Making sure that there is a PBS plan in place. Making sure it is updated and keeping everyone in the loop. #WeLDNs
@WeLDnurses
19 November 2019 21:01
This sounds fantastic! Are you able to share the kinds of things that they do? #WeLDNs https://twitter.com/zoeeuk/status/1196895535971606528
@linzisueboo
19 November 2019 21:01
@LiamFreeman1991 @Cathy_55555 @WeLDnurses I remember reading a blog post by a mother whose son has LD & autism. They found a lovely home they liked, but their care manager changed and he said they had to go for cheapest bidder of 3 & her son didn't like the place they were sending him to. #WeLDNs
@ross_6479_RNLD
19 November 2019 21:01
@zoeeuk @WeLDnurses Totally agree, I always push for not settling and looking for what fits the need, this is another factor in readmission #WeLDNs
@lynnewalsall
19 November 2019 21:01
RT @WeLDnurses: This sounds fantastic! Are you able to share the kinds of things that they do? #WeLDNs https://twitter.com/zoeeuk/status/1196895535971606528
@LiamFreeman1991
19 November 2019 21:01
#WeLDns #EBP https://twitter.com/LiamFreeman1991/status/1196896041863393281
@WeLDnurses
19 November 2019 21:02
This is such an important point, thank you @Shaun_LDNurse #WeLDNs https://twitter.com/shaun_ldnurse/status/1196895174032601088
@lynnewalsall
19 November 2019 21:02
RT @LiamFreeman1991: #WeLDns #EBP https://twitter.com/LiamFreeman1991/status/1196896041863393281
@Mermcm
19 November 2019 21:02
When anyone in our area is admitted to an AMH ward we inreach, attend ward rounds etc and provide support to the ward staff, we also provide ongoing training & support to AMH staff on the needs of PwLD #weldns https://twitter.com/LiamoJC/status/1196895908040003585
@LiamFreeman1991
19 November 2019 21:03
@linzisueboo @Cathy_55555 @WeLDnurses Oh wow, how shocking #weldns
@zoeeuk
19 November 2019 21:04
@WeLDnurses They chair the placement matrix which includes the professionals, family and the person and we discuss what they need and want from a new home including the environment, staff and activities which is compiled and sent to the care manager to look for a placement to match #weldns
@linzisueboo
19 November 2019 21:04
@WeLDnurses It's about knowing the individual, working with family & carers to create a person centred plan to address needs. MDT approach as well to address communication, sensory & physical health needs too. Put a crisis & contigency plan in place too #WeLDNs
@zoeeuk
19 November 2019 21:04
@WeLDnurses As close as possible obviously #weldns
@WeLDnurses
19 November 2019 21:04
Are you aware of any evidence base/ policies or documentation that suggest pathways or procedures to help reduce the chance of unnecessary admission? #WeLDNs
@WeLDnurses
19 November 2019 21:05
Who should make up the #MDT? #WeLDNs https://twitter.com/linzisueboo/status/1196897001121755136
@LucyAnn_Spencer
19 November 2019 21:06
@linzisueboo @LiamFreeman1991 @Cathy_55555 @WeLDnurses That's awful. I don't have any experience of the tendering process. I have heard stories like that though, which is so sad. It's so unfair that budget cuts could have such a detrimental impact on a persons life. #WeLDNs
@WeLDnurses
19 November 2019 21:06
@Mermcm Thanks so much for sharing @Mermcm #WeLDNs
@WeLDnurses
19 November 2019 21:06
RT @LiamFreeman1991: #WeLDns #EBP https://twitter.com/LiamFreeman1991/status/1196896041863393281
@WeLDnurses
19 November 2019 21:07
RT @Mermcm: Support the providers, support the Commissioners - make use of the data and local knowledge #weldns https://twitter.com/WeLDnurses/status/1196894337315098626
@lynnewalsall
19 November 2019 21:07
#weldns the person - their chosen supporters and professionals who can help to support the individual https://twitter.com/WeLDnurses/status/1196897383856128005
@CommunityLd
19 November 2019 21:07
@WeLDnurses I like it when they’re nurse led and have input from psychiatry, psychology, occupational therapy and speech and language. Utilising collective leadership can help reduce reliance on medical model #weldns
@LiamFreeman1991
19 November 2019 21:08
@WeLDnurses Reducing pediatric psychiatric hospital readmissions and improving quality care through an innovative Readmission Risk Predictor Tool https://onlinelibrary.wiley.com/doi/abs/10.1111/jcap.12203 This tools used in America for mental health but it showed reduction in readmission over time #ebp #weLDns
@WeLDnurses
19 November 2019 21:08
What services are you aware of that support an individual following discharge from a mental health unit? #WeLDNs
@Mermcm
19 November 2019 21:09
The most appropriate people for that need - may be Nursing, Psychiatry, Psychology, SLT, OT, Psychology. Depends on need #weldns https://twitter.com/WeLDnurses/status/1196897383856128005
@Shaun_LDNurse
19 November 2019 21:09
@WeLDnurses 2. ... to family dynamics etc). If we really are the “go to” professional to make those crucial referrals to other professionals, then we’ve really got to be more proactive. [that’s not to say some #RNLDS aren’t already, they are - they do a fab job]. #WeLDNs
@linzisueboo
19 November 2019 21:09
@WeLDnurses Depends on the individual. Often it's psychiatrists, psychologists, behaviour support specialists, nurses and then we may have SALT, OT, & physiotherapy (If communication, sensory, skills & mobility needs addressing). We often have CCG & social care managers too #WeLDNs
@paularich1977
19 November 2019 21:09
@LucyAnn_Spencer @linzisueboo @LiamFreeman1991 @Cathy_55555 @WeLDnurses I have witnessed the more expensive option being chosen for an individual and being agreed by the panel... I guess that’s down to the argument the MDT provided as to why it was the best option for the individual... #weldns
@ross_6479_RNLD
19 November 2019 21:09
RT @WeLDnurses: What services are you aware of that support an individual following discharge from a mental health unit? #WeLDNs
@LiamFreeman1991
19 November 2019 21:09
@WeLDnurses Possible chance to produce one for pw/LD and autism #Weldns
@LucyAnn_Spencer
19 November 2019 21:09
RT @WeLDnurses: What services are you aware of that support an individual following discharge from a mental health unit? #WeLDNs
@linzisueboo
19 November 2019 21:10
@LucyAnn_Spencer @LiamFreeman1991 @Cathy_55555 @WeLDnurses In some cases somebody finds a placement that is suitable and they like, but it takes so long to agree funding that the vacancy goes. #WeLDNs
@CommunityLd
19 November 2019 21:10
@WeLDnurses There are some good examples of wrap around models of care where specialist teams become involved at point of admission to facilitate discharge and post care/support #weldns
@LiamoJC
19 November 2019 21:10
@CommunityLd @WeLDnurses I don't think the discipline of the Team Manager is important but the person has the correct leadership skills? #weldns
@WeLDnurses
19 November 2019 21:10
As nurses how could we be more proactive? #WeLDNs https://twitter.com/shaun_ldnurse/status/1196898215599194112
@salsa442
19 November 2019 21:10
RT @WeLDnurses: As nurses how could we be more proactive? #WeLDNs https://twitter.com/shaun_ldnurse/status/1196898215599194112
@zoeeuk
19 November 2019 21:11
@WeLDnurses Well eventually when they are ready, support into social activities which will support overall wellbeing *shameless plug* #stayuplate #weldns
@linzisueboo
19 November 2019 21:11
@WeLDnurses Often the nurse will take on the co-ordination role and bring the various professionals, service user & carers together. #WeLDNs
@ross_6479_RNLD
19 November 2019 21:11
@paularich1977 @LucyAnn_Spencer @linzisueboo @LiamFreeman1991 @Cathy_55555 @WeLDnurses Good strong service specification developed with the individual, their family/carers and the MDT can help support decision making, ensuring it is backed by evidence, I’ve been able to successfully use this to have new homes approved #weldns
@CommunityLd
19 November 2019 21:11
@LiamoJC @WeLDnurses Slightly mistyped but emphasis on collective leadership #weldns
@lynnewalsall
19 November 2019 21:11
RT @WeLDnurses: As nurses how could we be more proactive? #WeLDNs https://twitter.com/shaun_ldnurse/status/1196898215599194112
@HabitualJoshing
19 November 2019 21:11
@WeLDnurses I’ve found limited studies exploring this. There’s a few that suggest people with mild learning disabilities are most at risk, along with those with greater independent living skills #weldns
@LiamFreeman1991
19 November 2019 21:12
RT @WeLDnurses: What services are you aware of that support an individual following discharge from a mental health unit? #WeLDNs
@Mermcm
19 November 2019 21:12
By working with the data we have within our teams and with colleagues in commissioning to predict need and put in place proactive strategies inc much more public health work! #weldns https://twitter.com/WeLDnurses/status/1196898596593061891
@linzisueboo
19 November 2019 21:12
@paularich1977 @LucyAnn_Spencer @LiamFreeman1991 @Cathy_55555 @WeLDnurses I have seen a very expensive placement go to one individual. It cost so much money, when it came to the CPA review, the room was completely packed, many of whom from the CCG & council who were funding. The funding was very much justified. #WeLDNs
@salsa442
19 November 2019 21:13
@HabitualJoshing @WeLDnurses I’d absolutely agree with this. In my exp definitely people with mild LD most at risk #WeLDNs
@paularich1977
19 November 2019 21:13
@ross_6479_RNLD @LucyAnn_Spencer @linzisueboo @LiamFreeman1991 @Cathy_55555 @WeLDnurses I may be completely naive... but surely if the more expensive option is the right option then ultimately it works out cheaper than picking the cheapest option and then having a readmission as a result... not rocket science really #weldns
@WeLDnurses
19 November 2019 21:14
How could services/ processes following discharge be improved to support the individual and prevent readmission? #WeLDNs https://twitter.com/communityld/status/1196898484693143555
@Mermcm
19 November 2019 21:14
In all areas of health ppl with mild LD are at greater risk I think as they usually manage ‘ok’ until something goes wrong and then the usual coping strategies/way of life don’t work #weldns https://twitter.com/HabitualJoshing/status/1196898880547360778
@linzisueboo
19 November 2019 21:14
@ross_6479_RNLD @paularich1977 @LucyAnn_Spencer @LiamFreeman1991 @Cathy_55555 @WeLDnurses Agreed. If you can put into writing why somebody needs a specific type of placement, it can often get approved. #WeLDNs
@ross_6479_RNLD
19 November 2019 21:14
@salsa442 @HabitualJoshing @WeLDnurses Agreed #WeLDNs
@zoeeuk
19 November 2019 21:14
@paularich1977 @ross_6479_RNLD @LucyAnn_Spencer @linzisueboo @LiamFreeman1991 @Cathy_55555 @WeLDnurses I guess it depends on the CCGs #weldns
@LiamFreeman1991
19 November 2019 21:14
@HabitualJoshing @WeLDnurses I also find that as well, I mainly found research around readmission rates and recommending community team to help support transition into community #weldns
@linzisueboo
19 November 2019 21:15
@paularich1977 @ross_6479_RNLD @LucyAnn_Spencer @LiamFreeman1991 @Cathy_55555 @WeLDnurses You're right, but I think they have to prove that it is justified. #WeLDNs
@paularich1977
19 November 2019 21:15
@WeLDnurses Duplicating the support given that ensured the person was fit for discharge... ensuring the right input from the right people is still available #weldns
@HabitualJoshing
19 November 2019 21:15
@WeLDnurses Interestingly, an older study (2000) by Seaver, Bell and O’Brien found a physical deterioration figured highly as a cause of readmission #weldns
@WeLDnurses
19 November 2019 21:15
Getting it right from the start is crucial, should it matter if it is the more expensive option at the time? #WeLDNs https://twitter.com/paularich1977/status/1196899377425657858
@LiamoJC
19 November 2019 21:16
@Mermcm I disagree, I find those with Mild LD often have more problems with exploitation, are more sexually vulnerable and those who have kids then come in contact with child protection services. They are often more hidden on the fringes of society #weldns
@WeLDnurses
19 November 2019 21:16
Very interesting! #WeLDNs https://twitter.com/habitualjoshing/status/1196899924237062146
@zoeeuk
19 November 2019 21:17
@WeLDnurses No it really shouldnt however money will always be discussed and sometimes an issue especially if the funding is shared between health and social #weldns
@Mermcm
19 November 2019 21:17
Also we have to remember capacity and that people can/do make ‘unwise decisions’ about their health, our role is to provide info/advice/support not to eliminate all risk #weldns https://twitter.com/Mermcm/status/1196899482568478723
@linzisueboo
19 November 2019 21:17
@WeLDnurses By making sure that support plans, guidance, recommendations, risk assessments & crisis plans are all in place & not waiting for something to go wrong before taking action. #WeLDNs
@WeLDnurses
19 November 2019 21:18
Who should be responsible for implementing services or processes following discharge? #WeLDNs
@WeLDnurses
19 November 2019 21:18
Brilliant point! #WeLDNs https://twitter.com/linzisueboo/status/1196900436168577025
@ross_6479_RNLD
19 November 2019 21:19
RT @WeLDnurses: Who should be responsible for implementing services or processes following discharge? #WeLDNs
@Mermcm
19 November 2019 21:19
@LiamoJC I’m not sure what you disagree with that was part of my point! #weldns
@LiamFreeman1991
19 November 2019 21:20
@WeLDnurses All-Cause, 30-Day Readmissions Among Person With Intellectual and Developmental disabilities and Mental Illness https://doi.org/10.1176/appi.ps.201600534 Recommended tailored discharge planning and well-supported community placement #weldns #ebp
@WeLDnurses
19 November 2019 21:20
Are you aware of any assessment tools that can help predict the chance of readmission? #WeLDNs
@ross_6479_RNLD
19 November 2019 21:20
@WeLDnurses There should be a collaborative responsibility with all members of the MDT supporting and working together to identify and work through any issues raised/identified imo #weldns
@Mermcm
19 November 2019 21:21
@LiamoJC People ‘bumble along’ on the fringes and get by until there is a crisis and then they come to the attention of services #weldns
@martin_robb
19 November 2019 21:21
@WeLDnurses wrap around services that start work with the individual during the admission and beyond are effective at reducing readmission. Ensuring a person placement specification that the person and the carers are signed up to is essential. #WeLDNs
@linzisueboo
19 November 2019 21:21
@WeLDnurses Council/CCG funding the provision should be responsible for ensuring that the placement is suitable & that the appropriate support by suitably trained staff is in place before they move. It is then down to care co-ordinator to ensure joined working & regular care reviews #WeLDNs
@zoeeuk
19 November 2019 21:21
@WeLDnurses I would say the care manager for that person which I've noticed can be a Nurse, OT, Social Worker, Psychologist and I'm sure many more! #weldns
@heckyotoole
19 November 2019 21:21
RT @WeLDnurses: Are you aware of any assessment tools that can help predict the chance of readmission? #WeLDNs
@CommunityLd
19 November 2019 21:21
@WeLDnurses A dynamic risk assessment would be needed. Something like HCR20 can be used to rate risk factors on and ‘out and in’ basis #weldns
@WeLDnurses
19 November 2019 21:22
Do you think there’s any way to help those individuals before they hit crisis point? #WeLDNs https://twitter.com/mermcm/status/1196901244817854465
@martin_robb
19 November 2019 21:22
@WeLDnurses Private providers being open and transparent about what they can deliver on #WeLDNs
@lynnewalsall
19 November 2019 21:23
RT @WeLDnurses: Do you think there’s any way to help those individuals before they hit crisis point? #WeLDNs https://twitter.com/mermcm/status/1196901244817854465
@lynnewalsall
19 November 2019 21:23
RT @martin_robb: @WeLDnurses Private providers being open and transparent about what they can deliver on #WeLDNs
@ross_6479_RNLD
19 November 2019 21:24
@WeLDnurses Assessment and formulation is key here, too often someone’s capabilities are ‘assumed’ and this is where care needs (or perceived lack of) are missed or misinterpreted #WeLDNs
@Mermcm
19 November 2019 21:24
Much more proactive/preventive working, supporting mainstream/voluntary sector to identify & refer where necessary, LD Nurses embedded in local communities & working with marginalised groups (my dream!) #weldns https://twitter.com/WeLDnurses/status/1196901613585260544
@DrAnthea
19 November 2019 21:24
@WeLDnurses #weldns I work as an rnld on a mental health ward and we are seeing an increase in admissions of people with learning disabilities and asd recently it feels like community services are stretched and struggling to offer more intensive support for people with complex needs
@linzisueboo
19 November 2019 21:25
@WeLDnurses By making sure they have their annual health check at GP and their annual service review through social services to improve chances of picking up any signs of changes. Make sure we have a good history of physical & mental health needs & potential triggers too. #WeLDNs
@WeLDnurses
19 November 2019 21:25
RT @DrAnthea: @WeLDnurses #weldns I work as an rnld on a mental health ward and we are seeing an increase in admissions of people with lear…
@paularich1977
19 November 2019 21:25
@WeLDnurses Difficult because as they “bumble along” they are often under the radar. I think signposting to services should they need them, ensuring people know where to go should they need support and also ensuring annual health checks are taken up #weldns
@LiamoJC
19 November 2019 21:25
@WeLDnurses It can involve a multi-agency approach and clear identification of the 3 priority goals and then a collaboration to achieve same. Housing or Acute needs or enchanced care package may be needed first #teamwork #teamwork #weldns
@lynnewalsall
19 November 2019 21:25
RT @DrAnthea: @WeLDnurses #weldns I work as an rnld on a mental health ward and we are seeing an increase in admissions of people with lear…
@WeLDnurses
19 November 2019 21:25
Thank you for sharing your experience! Has anyone else seen this? #WeLDNs https://twitter.com/dranthea/status/1196902120009666567
@CommunityLd
19 November 2019 21:25
@martin_robb @WeLDnurses There’s an autism service in north east that requires commissioners to sign up to an 18-month maximum length of stay and, most importantly, funding guarantees for discharge #weldns
@ross_6479_RNLD
19 November 2019 21:25
@DrAnthea @WeLDnurses This as well as reduced number of Learning Disability beds resulting in increase in use of mental health beds when people need admission ime #WeLDNs
@WeLDnurses
19 November 2019 21:26
Finally, what are you going to take away from tonights chat? #WeLDNs
@ross_6479_RNLD
19 November 2019 21:26
@WeLDnurses Yes, I’ve often scaffolded in to mental health wards in these situations #WeLDNs
@paularich1977
19 November 2019 21:26
RT @WeLDnurses: Finally, what are you going to take away from tonights chat? #WeLDNs
@ross_6479_RNLD
19 November 2019 21:27
RT @WeLDnurses: Finally, what are you going to take away from tonights chat? #WeLDNs
@martin_robb
19 November 2019 21:27
@WeLDnurses Not sure of assessment tools but dynamic support registers are being developed to help better understand the needs of those we serve so that community services are able to support those at risk of admission to hospital remain supported in their communities #WeLDNs
@DrAnthea
19 November 2019 21:27
@ross_6479_RNLD @WeLDnurses I genuinely had a mental health nursing colleague who had never ward of reasonable adjustment I was stunned #weldns
@lynnewalsall
19 November 2019 21:27
RT @WeLDnurses: Finally, what are you going to take away from tonights chat? #WeLDNs
@rebeccaedsbt
19 November 2019 21:28
@WeLDnurses We use the HoNOS-LD as monthly measure. Can highlight deteriorations #WeLDNs
@charlottebcafc_
19 November 2019 21:28
@WeLDnurses #weLDNs - I used to work on a working age adult male acute ward - certainly an increase in individuals with a learning disability being admitted to to acute wards.
@zoeeuk
19 November 2019 21:28
@WeLDnurses Well I'm positive we are all aware... but the importance of being person-centred and providing the best homes and services for people after discharge ?? #weldns
@Mermcm
19 November 2019 21:29
DSRs/‘risk registers’ are only as good as the inputs into them. Need all local services (not just LD teams!) signed up & understanding process. I developed a flowchart/briefing around this when I worked in a TCP #weldns https://twitter.com/martin_robb/status/1196902753735446528
@paularich1977
19 November 2019 21:29
RT @rebeccaedsbt: @WeLDnurses We use the HoNOS-LD as monthly measure. Can highlight deteriorations #WeLDNs
@LiamFreeman1991
19 November 2019 21:29
@WeLDnurses @CommunityLd signposting me to read about green light framework #weldns and it seems like there are many factors from social care to the Pw/LD going to provider that may not be able to support them #WeLDns
@zoeeuk
19 November 2019 21:29
@rebeccaedsbt @WeLDnurses My team does too, alongside the GCPLA and BPI #weldns
@paularich1977
19 November 2019 21:29
RT @LiamFreeman1991: @WeLDnurses @CommunityLd signposting me to read about green light framework #weldns and it seems like there are many f…




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