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Boundary spanning in health and care -a short profile of Steve Turner

July 20, 2017 By Steve Turner

People ask me ‘what exactly do you do for a living?’. Because I’ve been around a bit I sometimes struggle to answer this concisely, so here’s a short summary:

My career and experience:

After ten years of traveling around the world, I began my career as a nurse eventually specialising in mental health. My appetite for learning took me through a degree in Social Policy and then into the world of healthcare I.T.

I spent the next decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the US arm of the company, working with leaders of clinical teams in the NHS.

I then returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger.

A spell in consultancy for a large Cancer Network followed, by leading two multi-organisational projects to identify the most effective information and prescribing systems. These brought clinical teams together to manage a complicated buying system in a much more efficient and cost effective way.

More recently I have led a successful interdisciplinary, multi-organisational prescribing project and the development of a parent held medicines record for children with complex conditions. My Associates and I have also developed, and successfully piloted, ‘patient led clinical medicines reviews’.

All of these projects have received national recognition.

I have been a NICE Medicines and Prescribing Centre Associate, sharing related information /guidance & learning with a diverse group of NICE Affiliates, and documenting outcomes. I also continue to practice as a mental health clinician, focusing on several areas including mental capacity assessments and medicines management.

In 2015, after a difficult whistleblowing experience, I founded the Turn Up The Volume! movement and speak out for patient safety through transparency, values based leadership and a just culture. We have held two successful national events, bringing together people from all areas in an atmosphere of trust and learning.


Looking for someone who can engage people across boundaries? I’m available to speak at events and as a commentator.

Here’s Steve talking about one of our wellbeing projects:

Steve Turner

@MedicineGovSte

Click here for LinkedIn profile

info@carerightnow.co.uk

07931 919 330

Revised blog published: 10.09.2020

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Filed Under: Care Right Now, Jargon Buster, Leadership in Health, Medicines Optimisation, NICE, Organisational Culture, Prescribing, Transparency, whistleblowing, Workshops

Multi-morbidity & polypharmacy (taking 4 or more meds.)

May 15, 2017 By Steve Turner

Multi-morbidity and polypharmacy (that’s taking four or more medicines)

Taken from NICE Key Therapeutic Topics  pages 5-10.

Key points:

  • People with multiple illnesses are often prescribed multiple medicines, with new medicines being added to counter side-effects of others. The actual benefits of doing this are hard to ascertain.

Taking multiple medicines involves increased risks.

  • Everyone with multiple illnesses should receive a holistic person-centred review of their medicines and share in the decision making of what they take. (My view takes this further. I’d say ‘be given the option to lead on the decision making of what they take’).
  • Polypharmacy (taking four or more medicines) can be divided into two categories. Appropriate polypharmacy, where the benefits and disadvantages have been fully evaluated together. Problematic polypharmacy, where this hasn’t been done and the benefits of the medicines are not realised, sometimes to the extent that they are making the person worse.
  • There are some useful tools which can be used to help evaluate appropriateness of medicines in individuals (described in the document). Additionally I’d add that motivational interviewing techniques and time to build trust of the patients are also vital.
  • Intentional non-adherence can be overcome in a trusting clinician patient relationship, which usually happens over time.

#jargonbuster ‘intentional non-adherence’ = not telling clinical staff what you are actually taking and/or not taking.


More on the NICE Key Therapeutics Document here:


Personal views of Steve Turner RGN; RMN; Ba (Hons); P.G. Dip Ed; MIHM

Steve is a nurse prescriber and NICE Medicines and Prescribing Programme Associate.

You can follow Steve’s tweets @SteveMedGov

Steve is an Ambassador for @MedicineGov

Posting on #mentalhealth #MedsOpt #MedLearn #NICEGuidance #PatientEducation #substancemisuse #selfcare #prescribing 

Search under #MedLearn

LinkedIn profile here: https://www.linkedin.com/in/sjturner/

For more on Care Right Now’s Patient Led Clinical Education work-streams click here: http://www.carerightnow.co.uk/projects/

‘Phone 01872 248327

Or email steve@carerightnow.co.uk

 

For part one of this blog ‘Medicines are overused’ click on the image below:


 

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Filed Under: Academic Detailing, Elderly care, Jargon Buster, Medicines, Medicines Optimisation, NHS, NICE, Prescribing

Changing mindsets and delivering safe care in Cornwall together. #devocornwall

March 20, 2017 By Steve Turner

We want the best health care system in the world, & the most efficient and effective system …

We have an opportunity to do things differently in Cornwall

How do we achieve this?

 

The challenges in Cornwall

There’s a huge amount going on with health and social care in Cornwall. Including the Sustainability and Transformation Plan [STP]; exposure of abuse and neglect in care homes; concerns over hospital closures, delayed discharges taking up hospital beds, and devolution of services on the way.

Although I have worked in health and care for over 30 years, I struggle to keep up with the issues and understand how services are organised.  This isn’t helped by the current polarisation of views.

On the one hand we have a big dose of NHS and Council ‘spin’, excessive bureaucracy and even bullying. On the other hand we have public concern, often expressed around specific issues, and sometimes based on unfounded rumours.

Neither of these positions are helpful, and neither represent the vast majority of people (public, staff and patients) who just want good services delivered by kind people who are open, accountable and transparent.

#devocornwall

We have a great opportunity now with the devolution of health and care services. This will be realised if we all build bridges, and transcend the usual hierarchical boundaries. We all need to listen and learn. Everyone, to coin an overused phrase, needs to step out of their comfort zones.

Why we need to think differently?

Several community hospitals are under threat of closure, leading to anger and dominating the headlines. Less attention is given to identifying and measuring the benefits, and any disadvantages of community hospitals. For example, can they be staffed adequately, bearing in mind this means Doctors, Nurses, Physiotherapists, Radiographers, Dieticians, Speech and Language Therapists, Social Workers etc.? Is home care a viable option for patients and carers?  Are there any creative options such as bringing back the old style ‘convalescence’? Is rural isolation and lack of public transport the major issue?

It’s becoming increasingly difficult to book a timely GP consultation. This has led to several inaccurate scare stories in the press about ‘cuts’ to face to face GP contacts. This needs deep thought as there are times when easy access to a GP on the ‘phone, or on-line, may actually be a better option. Access to health information from Community Pharmacies or in NHS run clinics in shopping centres, or better health information and advice available locally, may be more effective approach. Leaving GPs free to spend more time with those who need their help and expertise most.

It’s now widely accepted that the NHS and Social Care is underfunded. Despite this there is still a great deal of duplication and waste in the system. How many times have you been asked to repeat information to Health Professionals which others already have? Do some services overlap, and are there gaps? Do different organisations link seamlessly with other organisations? Are all services accessible to all? Many people have important stories to tell on these areas of inefficiency.

Now’s the time to talk about this, find out what’s planned, and take action together. ‘Patient engagement’ key component of the STP and #devcornwall.

Patients and public need to take the lead on this. It’s not the NHS or Cornwall Council’s plan it’s ours.

Personal views of Steve Turner. MD Care Right Now CIC, a Cornish Company

Version 2

Date: 30/03/2017

This article is adapted from a letter which fist appeared in the St Austell Voice

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Filed Under: Care Homes, Care Right Now, Children Health, CIC, Elderly care, Human Factors, Jargon Buster, Leadership in Health, Medicines Optimisation, NHS, Organisational Culture, Transparency, Uncategorized, whistleblowing

Pushing the boundaries

May 11, 2015 By Steve Turner

Pushing the boundaries

TwitterProfile

At Care Right Now we love pushing the boundaries. If someone, especially someone in ‘authority’, tells us it’s not possible it just makes us more determined.


 

For info there the latest on our work with people with long term conditions:
http://www.carerightnow.co.uk/condition-management/

…what do attendees on our course say?

‘You should listen to those guys. You will learn something’ April Attendee 2015.

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It’s the power of patients and the public which will drive forward safer and more cost effective care, and this doesn’t need complex jargon or rules, or to be stage managed by existing bodies.

Here’s another example of a successful project which pushed the boundaries:
http://www.carerightnow.co.uk/parent-held-medicine-records/

Oarent Hel record


 

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Author: Steve Turner 11/5/15

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Filed Under: Care Right Now, Children Health, CIC, Human Factors, Jargon Buster, Leadership in Health, Medicines, MEDSINFO, NHS, Organisational Culture, Transparency, whistleblowing

Medicines Optimisation – what does this mean?? Jargon Buster

August 5, 2014 By Steve Turner

iStock_000010802947_Large (2)

These accounts are all fictitious but based on real events:

Ben’s holiday – (finding out what a medicine does by accident) :

Ben is a 16 year old boy who has been prescribed a drug for a behavioural condition, it’s a powerful drug (called an antipsychotic) which he has taken for over a year. His parents think it helps, Ben hasn’t said what he really thinks, but accepts the tablet.

A few years ago the family went on holiday to Bulgaria. During the holiday the volcano with the unpronounceable name in Iceland erupted. The family were stuck in Bulgaria waiting for the ash cloud to blow over. They ran out of Ben’s medicine and were unable to obtain any or anything similar. As a result, out of desperation, they gave Ben a saccharin tablet instead, and hoped for the best. He was fine. Over the next few weeks they even noticed an improvement in his mood and behaviour. He seemed to be enjoying life more. When the family returned to the UK they stopped giving him the ‘placebo’ tablets, and he has not needed to take medicines since.

Ian’s secret: (in jargon this is ‘intentional non-adherence’)

Ian is a 35 year old man diagnosed with bipolar disorder. When Ian moved to another part of the country he was allocated a new community psychiatric nurse [CPN] and, as he was unwell at the time, was re-started on medication. Over the next 18 months Ian’s condition improved so his CPN reported a ‘good response to the medication’. It was only after 2 years of knowing him that Ian confided in his CPN that he didn’t take the medication consistently, and never had.

The medicine was lithium, which requires regular blood tests. This is because too much of it is toxic and too little has no effect. Ian revealed that he had only taken it before his blood test days, then always stopped taking it in between.

Ian’s medical notes had stated that he always ‘responded well to lithium’! As a result of Ian being able to trust his CPN, and let on that he wasn’t taking it, his medical records were corrected to say that he did not want to be prescribed lithium, confirming that other options worked much better. These options include some medicines which he had previously ‘borrowed’ from someone else, or bought on the internet. Of course he didn’t tell medical staff about this at the time.

So his choice is now clearly written up, should he become unwell again.

…and now the ‘science bit’. If you want them I can provide references for medicines geeks like me! steve@carerightnow.co.uk

Medicines Optimisation is a powerful term because it brings in the:

  •    Patient’s views and their decision

Clinical people may think they ‘know best’, but in the end it is  the patients (you and I) who will decide whether or not we take the medicine, and we will not always tell the doctor or nurse if we don’t feel we can trust them. Statistically around 50% of people, (all ages all type of people), don’t take their medicines as prescribed.

  • The ‘human factors’ and health beliefs related to having to take medicines

Medicines aren’t always the answer. We may have strong beliefs in favour or against them; these beliefs are hard to change and need to be respected. Basically we usually know what’s right for us.

  • The ‘evidence base’, which means is it known to work?

 People who prescribe medicines (usually doctors or nurses who have the qualification) need to offer the medicines which are proven to be most effective. And there is often a choice.

Repeatedly studies have shown that clinicians have a list of medicines they prescribe for various illnesses in their minds, and this list may bear little or no relation to the evidence available on what works best.

Medicines optimisation is not simply another term for ‘medicines management’, which is generally used to refer to the mechanics of the medicines process. This leads us to consider not just the process of selecting, prescribing; ordering; supplying; administering and monitoring, but also whether the person has enough knowledge to decide to take a medicine, actually takes the medicine and indeed whether the medicine is needed in the first place.

Sometimes people need multiple medicines (referred to as polypharmacy) because of the complexity of their illnesses, but this can be inappropriate if, for example, a medicine is simply added to counteract the side-effect of another medicine.


Author: Steve Turner Head of Medicines & Prescribing @MedicineGov & an Associate Lecturer at Plymouth University.

Click here for Steve’s digital profile


Updated: 28.01.0221

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Filed Under: Jargon Buster, Medicines, Medicines Optimisation

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