The Introduction of Key Working
within the Inpatient Setting of
St Patrick’s University Hospital
NMHSC Symposium 7/2/12
Steve Douglas (Nurse Practice Development Coordinator)
Catalysts for Implementation of Key
Working
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Consistent with ongoing efforts to gain full
compliance with Articles 15 & 16 of
Approved Centre Regulations/ Quality
Framework.
Recognised as medium term objective for
SPUH.
Code of Practice on Admission, Transfer &
Discharge to and from Approved Centres.
(MHC, 2009).
Clinical Governance
As part of the review of the C.O.P. on Ad, Tran &
Dis - a plan to achieve compliance was drafted by
the Clinical Governance Committee in SPUH. In
relation to Key working the following actions were
agreed:
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Chair appointed and terms of reference drawn for Key
Worker –working group.
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All disciplines invited to send representation.
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Met 3 times within a short timeframe and proposals
presented to the Clinical Governance Committee for
approval.
Throughout the process each of the disciplines liaised
within their own departments to ensure the basic principles
of change management were followed and to make the
process more robust.
Preparation for Introduction

Multiple presentations to all disciplines, including out of
hours to accommodate shift patterns of nursing staff.
– Changes in practice/policy explained and implications
discussed.
– Reasons for change explained and attention drawn to the
C.O.P. Ad, Tran & Dis (about Key Worker and more broadly
about all new obligations, particularly in relation to discharge
preparation).
– Staff informed of the change management process followed
and rationale for our interpretation of the Key Worker System.
– Consultation with the Hospital Consumer Council re Service
User information on the role of the Key Worker
The SPUH Key Worker System
Appointment of a Key Worker & Associate Key
Worker
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All Disciplines from within the MDT to participate in Key Working.
Consultant as the chair of the MDT will ensure the appointment of
a KW & AKW (in consultation with the MDT), for each patient at
the first MDT following their admission.
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The consultant will also identify a team member to be the chair in
their absence (in consultation with the MDT).
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The Associate Key Worker will carry out the responsibilities of the
Key Worker in their absence.
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Communication between the K.W. & the A.K.W. will take place
regularly in order to ensure periods of absence are covered and to
enable the A.K.W. to be able to act as K.W. at times of
unexpected absence.
Education of Clinical Staff Re
SPUH Key Worker Role
Structured around the following elements:
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Coordinating all stages of the resident’s stay in the
approved centre, including discharge planning.
Liaison with - resident, family, carer and /or chosen
advocate; MDT colleagues and relevant outside agencies (in
particular before prior to discharge/transfer).
Review written communication made by the primary
professionals involved regularly. Prior to Discharge - ensure
the MDT Discharge Plan and all relevant documentation has
been completed by the appropriate members of the MDT.
Key working is not a substitute for professional roles
and duties
Information & Awareness
Building for the Service User
As part of a broader effort to improve service user perceptions
regarding their care planning, a number of on-going initiatives
have been implemented to raise awareness about care
planning and related concepts (such as key working):
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Service user morning lecture introduced on this
topic
An information leaflet produced and widely
circulated
An information leaflet specifically designed to aid
the key workers explanation of the role in SPUH
introduced
Nurse delivered recovery information groups
content amended to include care planning info
Key working is not a substitute for
professional roles and duties
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Where clinical issues arise from Service User contact within
the role of the KW these are to be brought to the attention of
the MDT or the appropriate professional, within a time frame
in keeping with the level of urgency.
Key working should not preclude Clinical staff from
communicating directly with families, carers, external
agencies/professionals.
The co-ordination of treatment is overseen by the MDT
function and the “person responsible” on the weekly MDT Care
Plan Review should be maintained.
In instances where key worker issues arise out of hours or
when the key worker or associate is not contactable then
clinical staff should deal with them if urgent and/or
communicate them via the care plan.
Reasons for Positive
Implementation
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Already reasonably established structures for MDT
meetings and Care Planning.
New process whereby Consultant was formally
identified as chair of MDT with responsibility for
appointing a Key Worker and Associate Key Worker.
Key working ensured named accountability at all
stages of the service user’s stay in Hospital, rather
than relying on shared accountability and does seem
to have strengthened the care planning & discharge
planning process.
A variety of staff initiatives to increase service user
awareness about their care plans, multidisciplinary
teams and key working
Threats to Continued Success
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Need to ensure complacency doesn’t set in,
following 2 successive years of achieving full
compliance with MHC inspection standards.
Needs to be kept on the Clinical Governance
agenda for the foreseeable future and reviewed
accordingly.
Did present a challenge for Allied Health
disciplines, as some perceive their involvement in
Key Working to be a significant shift in their role.
A lot of work was needed to clarify the role and,
in particular the limits of the role. This is ongoing to some extent as the system is bedded in
and staff become more comfortable and
proficient in the Key Worker role.
Quality Improvement Cycle
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Audit – now a regular clinical audit.
Service User feedback through discharge
satisfaction questionnaire and Quality Care Service User Lectures.
Management by walk around – including
feedback to clinical staff.
On-going education/feedback for MDTs guided by
audit and management by walk around findings.
Thanks to the working group.
 Damien
Nolan, Edel Crehan, Sarah
Carter, Michelle Phoenix, Emma
Dunne, Gavin Rush, Michael Finn,
Fionn Kelly, Toni O’Connor, Edel
Fortune, Paula Keeshan, John
Creedon, Paulina Kowalska-Beda.