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Transforming Dementia Care within Royal Cornwall Hospital Trusts

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Title: Transforming Dementia Care within Royal Cornwall Hospital Trusts


1
Transforming Dementia Care within Royal Cornwall
Hospital Trusts
  • Dr Fiona Boyd, Dementia Lead.
  • Bev Chapman, PCT Lead
  • Maggie Trevethan, Clinical Nurse Lead

2
Past ,Present and Future
  • Service development to date
  • Ongoing projects
  • Our vision

3
To date.
  • Ongoing over 5 years
  • Shared care philosophy
  • Designated clinical lead
  • Designated ward base
  • Collaborative working

4
Long Term Condition
  • Diagnosis
  • Maintenance
  • Complex
  • Palliative

5
Dementia Mapping - Comparison figures 2006-2008
  • Bed base 588
  • nTD 69 (11)
  • nDementia57(10)
  • nDelerium9(1)
  • Bed base 538
  • nTD74(13)
  • nDementia57(10)
  • nDelerium17(3)

6
Correlation between delay in discharge and those
patients with cognitive impairment
  • A direct positive correlation between delay in
    discharge and those patients with cognitive
    impairment who demonstrated evidence of
    disability. 2008

7
  • 66 of these patients are located within the
    Medical Directorate.
  • 45 of all cognitively impaired patients in RCHT
    Eldercare setting
  • 30 individuals - bed-blocking whilst they
    awaited discharge from hospital to care home
    environments.

8
The RCHT Memory Service provides
  • Diagnosis (with a front door service)
  • Rapid access to investigations and assessments
  • Designated ward with specialty trained staff
  • Guidelines and Care Pathways
  • Supervision reduction in prescribing(sedation
    antipsychotics)
  • Patient and Carer support
  • Improved Awareness and Education

9
Guidelines and Pathways
  • Guidelines
  • Dementia
  • Acute Confusion
  • Palliative Care
  • Pain management
  • Mental Capacity
  • Anti-psychotic prescribing
  • DOLS
  • Pathways and other
  • Behavioural Chart and assessment tools
  • Cognitive assessment tools
  • PAINAD
  • Carers support
  • Life story books
  • Communication Alert scheme

10
Education and Awareness
  • Local to RCHT
  • Training F1/2, GP AND Specialty registrars
    trainees
  • PMS
  • Mental Capacity
  • DOLS
  • Lets respect -DoH
  • Competency Training for Nursing staff and allied
    specialties
  • Patient and Carers forum

11
Education and Awareness
  • Regional
  • Annual Eldercare Good Practice Day 2004-07
  • Dementia Away Day 2006
  • Lets Respect RCH(CIPS-Plymouth 2007)
  • Hospice Staff training 2008/09
  • Gp training day 2008/09
  • Community Matrons 2008/09
  • Dementia Academy 2009
  • Worried About Your Memory (Alzheimers Society
    2008-9)
  • BBC Radio Cornwall Phone-in (2008/09)

12
Education and Awareness
  • National
  • RCN The Journey End approach to palliative care
    (Cardiff 2007)
  • RCN Lets Respect Communication Alert System(
    Edinburgh 2009)
  • National Palliative Care Conference (7th)
    Palliative care in Dementia (Glasgow 2008)
  • Psychiatry Mental Health Communication Alert
    Scheme (Leeds 2009)
  • RCN Communication Alert Scheme(Edinburgh 2009)

13
Other Related Activities
  • OPMHG -Cornwall
  • Participation in Developing Cornwall Strategy
  • Regional Audit

14
Joint PCT/RCHT Audit of Nursing Home Admissions
  • Dr Fiona Boyd
  • Bev Chapman
  • Kylie Cook
  • Maggie Trevethan

15
Aims
  • Retrospective Audit
  • Admissions involving NH
  • Identify the appropriateness of the admission
    with a view to developing pathways to reduce
    admissions and facilitate more effective patient
    journey

16
Reference details Audit number   NHS
Number Care home   Sex Age Time of
admission     DOA DOD LOS     Referral source
GP/ A E SB GP yes/no   Ward
allocation(s) 1 2 3 4   Reason for
admission   Diagnosis (es) 1 2 3 4     P
rescribing issues Yes /No If yes,
comment     Nursing needs Yes/No   If yes
date of request date actioned Review
date   Delaying factors     Place of
discharge     Possible alternatives to
admission  
17
Provisional Data Jan-March 2009
  • Total Number Admissions 91
  • Length of Stay 1421 bed days
  • See by GP before admission 27 (30)
  • Required admission 10 (37 of reviews n/11 )
  • Seen Out of Hours 59

18
Breakdown of Admission Types
19
Other
  • General breathlessness
  • fatigue/exhaustion/SOB (12)
  • Admission from CPT
  • Step up care (4)

20
Other important Findings
  • Palliative 29 (32)
  • Treatment feasible in the Home 64 (70)

21
Whats Next?
  • Analyse all data and correlate results
  • Clear patterns
  • End of Life Care
  • Appropriateness of Admissions
  • Links with Advanced Planning for End of Life Care
    review of community care

22
Guidelines Dementia
  • Section 1 Dementia Pathway Summary
  • Section 2 What To Do on Admission and Why.
  • Section 3 How to Manage Difficult Behaviours.
  • Section 4 Dementia Assessment Tools and Care
    Plans
  • Section 5 Discharge Planning and Who To Contact.
  • Section 6 Assessing Capacity.
  • Section 7 Contact List of Community Mental Health
    Teams
  • Section 8 Appendices of Assessment Tools and Care
    Plans

23
(No Transcript)
24
24 hour behavioural chart

Time 24hrs
Agitation/ Restlessness
Violence/ Aggression
Care Refusal
Wandering
Fall
Pain
Sleep Disturbance
Settled
25
Guidelines Pain
  • gt 50 of elderly suffer from painful conditions
  • Pain control is frequently inadequate.
  • Demographic shift increase in elderly population
  • The number of patients with dementia who will
    experience pain is likely to increase.

26
Patients with Dementia
  • Experience communication difficulties
  • Lack understanding
  • Interpret and express their pain in ways

27
PAINAD
28
Guidelines Palliative
  • Understand the drivers to improving end of life
    care for those with dementia
  • Identifying terminal phase care
  • Practical measures (care pathways)

29
Key Aims
  • Determining whether someone is end stage
    using clinical diagnostic indicators and
    specialist support.
  • Identifying the patients needs (physical,
    psychological, behavioural)
  • Identifying and managing symptoms
  • Support to carers and families.

30
Best Practices covering
  • Pain Assessment (reference to Pain Pathway)
  • Airway toileting and respiratory symptoms
  • Physical hygiene
  • Nausea
  • Mouth care
  • Tissue viability
  • Bowel care
  • Pastoral Spiritual support.

31
What on For 2010
  • Re-launch Lets Respect campaign in
    collaboration with Worried About you Memory
  • Whats Your Story- Life Story Books
  • Education -Modular programme (In collaboration
    with Learning Development)
  • Completion of RCHT Dementia Strategy and Business
    Plan

32
Our Vision
  • Countywide Education Program (NVQ Training and
    diploma status County Wide resource)
  • Countywide Network Forum
  • Link Nurses for Dementia RCHT
  • End of Life advanced planning

33
In Summary
  • There is excellent leadership and ownership in
    advocating for dementia care in RCHT allowing
    multidisciplinary assessments and shared care
    with the psychiatric liaison services.
  • Continuous drive to improve quality of care

34
The Royal Cornwall Hospital
  • People with passion and vision.
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