‘Getting an evidence based journal club into practice in a medium secure forensic setting: process and changes

to practice’

9th March 2012

Chris Honey, Nurse Therapist

Clare Payne, Outreach Librarian

Overview• Partnership• Drivers, evidence

base.

• New approach• Aims and early outcomes.

Origins

• PSI Course • Critical Thinking

– What happens in practice afterwards– Losing impetus

• Knowledge and Library Service– Induction– PICO, Critical Appraisal– View of library service

• Clinically integrated learning• Journal Club

• Research Practice Gap

• Barriers to integration of knowledge into practice

• Barriers can be countered by the use of journal clubs– (Seymour et al., 2003, McQueen et al., 2006, Rassool, 2005,

Thompson, 2006, Parkes et al., 2004 –Cochrane review)

• Specifically shown to:– Foster EBP skills – decision making process - apply research findings in practice. – Shape positive research attitudes. (Goodfellow 2004, and Owen et

al 2001, McQueen et al 2006). – increase the likelihood of implementation of research findings

into practice. (Rizzuto et al 1994, Thompson 1997)

• Clinically integrated teaching – changes in behaviour

The evidence for a Journal Club:

Evidence Based Journal Club• Why an evidence based journal club?• Exploring the impact of journal clubs: a systematic review.• Components of a successful journal club

Evidence Based Journal Club Principles• Ownership

– To be question driven where the questions come from practitioners / participants

– Themes of importance to staff – Articles chosen by participants

• Practice Based

• Voluntary attendance

• Multidisciplinary– Consultant Occupational Therapist & Clinical Director, Nurse

Consultant & Research Lead, Consultant Psychiatrist, Nurse Therapist, Outreach Librarian

• Work based venue

Putting the evidence into Practice: Ownership & Practice Based

• MDT meeting generated 36 questions

• Leave• What are the criteria used in the

decision making process that is adopted when initially granting / cancelling / reducing leave of absence (LOA) in a medium secure setting?

• How are decisions about the duration, location and frequency of leave, arrived at and what are the risk factors considered for increasing such parameters?

• Seclusion• How can the exit of seclusion within

a secure forensic setting, be best managed in terms of reducing the risk of harm to self or others?

• Activity and meaningful occupation of time

• What is the contribution of engagement, occupational activity or structure / routine to reducing stress levels in service users with mental illness and staff ?

• Fitness for Police Interview• What is the evidence base

involved in clinical decisions as to whether a person is fit to be interviewed by police?

• Treatment• How should the prescription of

anti-psychotic medication be affected by how heavily a person smokes tobacco?

Ownership: Choosing the articles

• Process – Partnership with facilitation team

• Shared expertise

• Finding articles that met our needs

• Shared decision making

• Insight

Validity, Reliability, ApplicabilityValidity, Reliability, Applicability

Key Sessions

• Seclusion / Management of Violence and Aggression– Patient restrictions: Are there ethical alternatives to seclusion and

restraint?– A clinical improvement project to develop and implement a decision

making framework for the use of seclusion.

– Prof. Richard Whittington, University of Liverpool

• Meaningful Activity– Q? How will increasing activity affect inpatient service user

presentation?• 'An occupational perspective of the recovery journey in mental

health' • Occupation, mental Illness and medium security: Exploring time use

in Forensic Regional Secure Units.

• Absconding while on leave

Results: Behavioural & attitudinal change

• Motivational• Improved reading habits• Critical & creative thinkers• Improved research awareness• I don’t need to get published to change practice• Raised awareness of KLS• Aims achieved!

Results: Practical outcomes to date• Multidisciplinary Working Groups

– Absconding• S17 Leave audit• S17 Decision making template

– Seclusion reduction• Improved relational security• Improved Patient Experience

– Meaningful activity audit• CQUIN – Improve current uptake

Action Learning Cycle

Next Steps• Current practice needs to remain informed

by the evidence base.

• Research champions

• Working groups to recommend amendments or new additions to practice.

• Evidence clinical impact – Quality Strategy

• Journal club series 2– Service user involvement

• Business case for a clinician in the KLS!!

Conclusion

• KLS + Clinicians = Vital partnership!

Thanks

• Everyone who attended and got involved

• The facilitation Team

• Professor Richard Whittington

Any Questions