How was it for you? Reflections on involvement

This edition, we meet Andrew Grundy, who is involved in the Safer Transitions project in our Safer Care Systems and Transitions research theme.

Why did you decide to become involved in the Safer Transitions project?

I accepted an invitation to become involved in the Safer Transitions project because I am a mental health service user with lived experience of mental health service transitions myself; community to inpatient, and back again, on a number of occasions.

I also have research interests this area – my interests are in service user’s experiences of mental health services. My PhD is focussed on service users’ experience of risk assessment and management in an acute setting, which (among other things) involved sitting in and observing ward rounds and discharge meetings.

I wanted to use my lived and learned experience to make a difference in this area of hospitalisation discharge. We know that staff can become so focussed on the process that they lose sight of the person, and service users often feel lost in the system. So I feel it is important to constantly remind people that it is service users and carers who we hope will benefit from the research we do.

How do you think the Greater Manchester PSTRC has benefitted from your involvement? What difference do you feel that you made?

My involvement has focussed on assisting with the design and conduct of a study on the development of a Core Outcome Set for mental health hospitalisation discharge interventions – that is, a fundamental set of outcomes that we hope would be used in all future research into mental health discharge. This involved making the online study information sheet and surveys accessible and acceptable to a lay audience.

I have also been involved in co-producing an intervention to improve the service user experience of hospitalisation discharge. I’ve been involved to bring the service user experience and perspective into consideration when coming up with potential ideas in this area, and I’m excited about the next steps (watch this space!).

How do you feel you have benefitted from your involvement?

I’ve definitely picked up more research understanding and skills, particularly around developing a Core Outcome Set and the Delphi method – the process for producing the Core Outcome Set via an online panel completing various surveys, and then a face-to-face consensus meeting to agree the final outcome set.

I’ve also been able to use some of the most difficult experiences of my life (such as inpatient admissions) to make a difference to the research.

Would you recommend becoming involved in research to other patients/carers/health professionals? If so, why?

I would recommend being involved in the design and conduct of research, particularly if you have first-hand experience of a mental health condition (with all that entails) because you have a form of knowledge and expertise that people with only an academic knowledge-base don’t have.

The same is true if you are a friend or family member supporting someone with a mental health condition – that knowledge and experience is invaluable to academic researchers.

If you’re a health professional, your experience of clinical practice is also really helpful.

You may not feel like an ‘expert’ but clinicians, carers and service users have such a wealth of different kinds of knowledge that can make a real difference throughout the research process.

Research launched to investigate the gap in care following self-harm – call for patient/carer input

A study is underway investigating what helps patients’ access mental health assessments and psychological therapies following self-harm.  Despite the current clinical guidelines, there are wide differences in the services for people who self-harm and this study is designed to find out why.

Researchers at the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR Greater Manchester PSTRC), which is run as a partnership between The University of Manchester and Salford Royal NHS Foundation Trust are inviting patients and carers with experience of self-harm to complete an online survey as part of the new study which aims to help improve services in the future.

As well as a patient/carer survey, face to face interviews are underway with clinicians at 37 hospitals across the country, including Mersey Care NHS Foundation Trust, Greater Manchester Mental Health Trust, Pennine Care NHS Foundation Trust, and Manchester University NHS Foundation Trust. The results will be used to inform the design of better services for people who self-harm, as well as the National Suicide Prevention Strategy.

This comes at a time when an NIHR funded study published by the Lancet Psychiatry revealed self-harm is on the rise – trebling from 2.4% in 2000 to 6.4% in 2014.

Dr Leah Quinlivan, Lead Researcher, said: “Recent large-scale studies have shown increasing levels of self-harm across the country. Self-harm is a sign of significant psychological distress and is strongly associated with future suicide.

“Good quality clinical services are important to help prevent future suicide and repeat self-harm. This study aims to understand the gap between policy, so what is meant to happen, and what occurs in reality, and, crucially, why. If we can uncover what helps and does not help patients receive assessments and psychological therapies, we can develop strategies to increase access to these services, which will help to improve patient safety and contribute to suicide prevention strategies.”

The research team involved patients, carers, and clinicians in the development of the survey and the clinician interview study.  A member of the clinician advisory panel, Stephen Marks, Advanced Nurse Practitioner Trainee, said: “I think this is a really valuable study because it’s tackling an important patient safety issue which needs to be addressed. Good quality, timely, and appropriate care for this client group is undoubtedly associated with positive outcomes related to self-harm reduction and suicide prevention. Involving frontline clinicians makes this research relevant and realistic, and helps to ensure that the findings are grounded in the reality of everyday clinical practice.”

Liz Monaghan who is a member of the study’s patient/carer advisory panel said: “By involving people like me with diverse lived experience of many aspects of mental health care, we have, as a group, been given an opportunity to shape and direct this research, hopefully adding relevance and insights about service provision which are only evident to those who have experienced it first-hand. I am immensely grateful for the opportunity to take part in ways which are meaningful and empowering.”

To take part in the patient/carer online survey visit – https://sites.manchester.ac.uk/mhapt/

If you are interested in taking part in the clinician interviews, please contact Dr Leah Quinlivan by email leah.quinlivan@manchester.ac.uk or phone 0161 275 0727.

Developing prescribing safety indicators for the prison setting

by Richard Keers

A project has just begun which aims to develop and test prescribing safety indicators in prison healthcare.

Prescribing safety indicators describe prescribing and drug monitoring practices that may place patients at risk of harm, and which should generally be avoided. Whilst these indicators have been successfully introduced into hospitals and general practices in the UK, they have not been developed specifically for use in prisons, where research tells us the needs of patients and the way in which medicines are used differs from other health care environments.

The project team hopes that this work will lead to the implementation of prescribing safety indicators across prisons to help improve care for prisoners.

The project team will work closely with prison pharmacists to develop, input and test the prescribing safety indicators within prison healthcare records. Testing will take place in cycles to maximise learning and to help ensure that the indicators capture the right information. Following this exercise, the project team aim to run an event with prison staff and researchers to explore the potential for these indicators to be deployed on a national scale.

The project team are aiming to use the findings of this work to plan and submit a funding application to continue building on this research area.

If you would like to learn more about this study please contact Richard Keers.

Improving injectable medicines administration safety in hospitals

by Richard Keers

A new project has recently got underway to explore whether a new intervention to reduce injectable medicines administration errors in hospitals would be practical and welcomed by nursing staff. It is hoped that this NIHR Greater Manchester PSTRC work will identify how this intervention will be best designed and introduced into hospitals so it has the highest chance of success.

The intervention involves changing the way staff perform ‘second checks’ on injectable doses, which research tells us can be a task that is vulnerable to mistakes leading to medication errors. It is also known that errors involving injectable medicines pose a risk to patient safety and that it is therefore important to support the staff responsible for the complex process of preparing and administering them.

This project involves carrying out workshops with nursing staff across hospitals within one NHS trust to find out what they think about the intervention, how they think it might be introduced and work day-to-day in the hospital, and what factors might influence how successful it is.

The work will also explore how the staff members think the intervention should be tested to see if it is successful in improving medicines safety and being adopted into everyday clinical practice.

The project team are aiming to use the findings of this work to plan and submit a funding application to continue exploring the potential of this intervention.

If you would like to learn more about this study please contact Richard Keers.

PSTRC leading innovative workshops in involvement and engagement

by Sally Giles

Patient and public involvement/engagement (PPIE) plays a pivotal role in the work undertaken by the Greater Manchester PSTRC. Dr Sally Giles (Research Fellow) leads on PPIE at the PSTRC.  She is innovative in her approach to PPIE and is keen to improve understanding across the research centre and beyond. Sally said:

“In patient safety, PPIE is particularly relevant and has so much potential. There remains some misunderstandings around it so I’m keen to help change that. I believe all research can benefit from the inclusion of PPIE.”

So far this year, Sally has led on two workshops, designed to help change the way public and patient involvement/engagement is both viewed and implemented in research.

The first, Difficult Situations, took place in March. It was first run in 2018 and made such a positive impact, researchers and contributors asked for it to be repeated.  Around  40 researchers and public contributors from the three PSTRCs came together to discuss how to manage difficult situations in PPIE.  It was designed to give attendees the tools and understanding to overcome some of the challenges that arise.  It’s a topic that’s often overlooked but can have an impact on research if not managed.

The day involved researchers and public contributors working together on various scenarios relating to some of the more common challenges in relation to PPIE, such as communication breakdown, emotional issues and social media.  The event was well received by attendees and there are plans to run it again for a wider audience. 

The second PPIE workshop took place in June – Taking the mystery out of Patient and Public Involvement and Engagement (PPIE) for data-intensive health research.  More than 40 researchers and 10 public contributors from across the faculty attended who work with large electronic health datasets and patient registries. The workshop was co-designed with the non-executive lay members of the PSTRC Executive Management Board. 

An important part of the day was a live demonstration of how PPIE can benefit researchers working with large datasets.  This involved a Research Associate at the GM PSTRC, David Jenkins, presenting his research to the PPIE panel on the day. 

The day made a significant impact on attendees:

“The one new thing I learnt was around the process of PPIE itself, choosing public contributors and how to perform the PPIE. It was so helpful.”

The team hope to re-run the workshop in the future and will be looking at other innovative ways of improving the understanding and implementation of PPIE.

PhD Fellow Focus: Rebecca Musgrove

by Rebecca Musgrove

Rebecca Musgrove joined the University of Manchester as an NIHR Greater Manchester PSTRC-funded PhD student in January 2019.  As part of the ‘Safety in Marginalised Groups’ theme, she is focusing on the epidemiology (how often and where diseases or healthcare events happen) of suicide and self-harm after discharge from Mental Health inpatient care.  She is particularly interested in the role of primary care and specialist mental health services in protecting against suicide in the period shortly after discharge.  She hopes to use the Clinical Practice Research Datalink (CPRD), a large UK dataset derived from a large network of GP practices, linked with hospital admission, mental health and mortality records to define a cohort.

Prior to taking up the studentship, Rebecca worked as a Senior Analyst with the Mental Health policy team at NHS England.  She used data from the Mental Health Services dataset and other relevant national collections to provide monitoring tools and analysis to support the implementation of the Five Year Forward View for Mental Health and the more recent Long Term Plan.  She holds a Master’s degree in Demography and Health from the London School of Hygiene and Tropical Medicine.  Prior to this Rebecca worked as a trainer and in operational management in community Sexual Health in London and as a Child Protection Manager in war affected communities internationally.

She is passionate about improving health outcomes and reducing premature mortality for people who experience mental ill health and hopes her PhD will provide evidence to support and further develop existing UK policy.  After completing her PhD she hopes to continue working closely with the NHS in a mental health-care research capacity.

Developing a resource to help healthcare professionals implement NICE guidelines for self-harm

by Jessica Leather

Jessica Leather joined the NIHR Greater Manchester PSTRC Marginalised Groups theme as a PhD Fellow in September 2018. Before coming to the University of Manchester she completed a MSc in Health Psychology at Liverpool John Moores University. Following her masters, she worked as a research assistant for a bowel cancer screening intervention for Black and Asian Minority Ethnic populations in Liverpool. Her main interests lie in behaviour change interventions, particularly involving healthcare professionals as recipients or agents.

Jessica’s PhD focuses on the development of an intervention to aid healthcare professionals in implementing the NICE guidelines for self-harm, supervised by Prof Christopher Armitage, Prof Navneet Kapur and Prof Stephen Campbell. Self-harm is a key risk factor for suicide; approximately half of people who die by suicide have a lifetime history of self-harm. Presentations in primary care for self-harm are a critical setting for healthcare professionals to identify suicide risk and intervene. However, it is unclear:

1. what is the rate of patients presenting with self-harm
2. whether healthcare professionals are aware of the guidelines for self-harm, and
3. which factors may influence whether or not healthcare professionals implement the guidelines.

Therefore, this project aims to understand the experiences of healthcare professionals when encountering patients at risk of self-harm, and develop an intervention to facilitate the implementation of NICE guidelines for self-harm.

Study 1 comprises a representative survey in which healthcare professionals will report how frequently they encounter patients, and how they typically respond when they believe someone is at risk of self-harm. The survey will capture details about any training or tools they have received to aid their assessment and management of self-harm, and whether or not these resources were sufficient. Existing scales will be used to measure specific factors that could be associated with implementing the guidelines, such as a dislike of them, or an over-confidence in clinical judgement. Finally, the survey will use models of behaviour change to identify the issues that need addressing to improve the implementation of the guidelines.

Study 2 comprises of semi-structured telephone interviews in which healthcare professionals will be able to suggest acceptable solutions to the specific barriers they face when trying to implement the guidelines, while expressing whether or not they think an intervention would be useful and feasible for them in their professional role. This work will form the basis for an intervention to facilitate the implementation of NICE guidelines for self-harm by healthcare professionals.