Dementia Patient Capable Hospital Care - NC Quality … nursing education by North Carolina Nurses...
Transcript of Dementia Patient Capable Hospital Care - NC Quality … nursing education by North Carolina Nurses...
Patient Centered Care for
Those who also have
Dementia
CCME CNE Course Announcement
Activity Title: Patient Centered Care for Those Who Also Have Dementia
The Carolinas Center for Medical Excellence (CCME) is accredited as an approved provider of
continuing nursing education by North Carolina Nurses Association, an accredited approver of
continuing nursing education by the American Nurses Credentialing Center's Commission
on Accreditation.
This activity has been awarded 1.0 contact hours of Continuing Nursing Education (CNE) credit
CCME utilizes industry accepted mechanisms to identify and resolve conflicts of interest. The
planners, faculty, and speakers for this activity have no unresolved relevant financial relationships
with commercial interests that could be perceived as a conflict of interest
CCME has received no commercial support related to this educational activity
In order to obtain credit, you must register, attend webinar, complete survey evaluation questions
before you leave the webinar and complete attendance attestation through SurveyMonkey tool by
April 28, 2014, the expiration date for awarding contact hours. We will then provide you with an
attendance certificate for your records.
Patient Centered Care
for those who also have Dementia
A story of possibility!
How big an issue is this?
Source: https://www.alz.org/alzheimers_disease_facts_and_figures.asp#quickFacts
Catalyst for Change
Her mantra: “What can I do
to help?”
Mary Anne
Because of Mary Anne
Picture of
Cheryl
Eleanor (Ellie) McConnell, PhD, RN, GCNS-BC Director of Grand Challenge in Dementia Initiative
John Barrett Mary Anne’s Husband
Cheryl Batchelor, MSN, ANP-BC, NEA-BC, FACHE, Adult Nurse Practitioner
“A difficult and frustrating journey”
• 2005 – Mary Anne diagnosed at age 54
• 2010 – Dementia advanced with significant symptoms beyond memory loss
• August 2010 from care at home to memory care facility – then another
– asked to leave each
• Finally admitted to state psychiatric hospital
The Journey Continues
• 2010 - 5 Hospital interactions within 6 months • Each could have gone better
• John and Geriatric Care Manager collaborated to write Mary Anne’s story
• Catalyst to improve care for patients with dementia
• Shared with Chief Nursing Office at local hospital
Chief Nursing Officer’s Perspective
• Aging Demographics
• System-wide Approach to Special Care Need
• Staff Competency / Education Needs
• Patient/Family Advisory Council (PFAC)
• Self Assessment / “Ground Zero”
The Challenge
Patient and Family Perspective
• Patients with dementia can’t speak for themselves
• Many staff, while good at their tasks, seemed oblivious of special needs
• Would the hospital see the necessity for making changes
• Would the hospital be open to input from “outsiders”
Hospital Perspective
• Care processes
– Do we ask the right questions?
– Do we organize care in the right manner?
• Staff capability
– Do they have the right knowledge?
– Do they have the right information about the person?
– Do they have the right skills?
– Which staff are most involved?
Response: Task Force with Diverse Perspectives and Talents Chartered
Composition • Interim Chief Nursing Officer • PFAC Member • Community Members • Physician champion • Nursing Staff Representation • Registration Staff • Case Management • Professional Development /
Staff Development
Scope
• Inpatient / ED Care
• Not addressed by TF – Behavioral Services
– Discharge Planning
– Food Services
– Home Care Services
Framework for Patient-Centered Dementia Care
Core Element How achieved
Increased awareness of special needs of patients with dementia
Staff education: All professions, all levels; Community education
Improved identification of those with dementia
Changes in hospital procedure (Grey Wristband)
Targeted assessment on admission to support PCC
Changes in nursing assessment elements and admissions database
New expectations about how care is given
Hands-on skills training using experts from AlzNC using a “train-the-trainers” approach
Evaluation Accredited CE evaluation data & Other sources
Shared understanding of what a dementia-friendly environment means
Ongoing CE and program development for all levels of staff, including booster sessions
Dementia care protocol Five components including Environmental Suggestions, Care Approaches, Communications
Roadmap
Leadership: Task Force
- Form Task Force
- Review Evidence & Best Practices
- Establish bench- marks & monitor progress
Education: Staff & Family
Nursing: - Train-the-trainer expectations & skills
Family: - Preparing for hospitalization: brochures & seminar
Medicine: - Annual symposium included sessions on dementia
Protocol: Develop, Implement, Sustain
- Admission assessment changed -Grey wrist-band for AMS implemented
- Protocol piloted & Spread hospital-wide
Task Force Timeline: April 2012 through May 2013
Discoveries & Insights
Family Caregiver Perspective
• New approaches are feasible, and truly make a difference
• Opportunity via PFAC membership to spread elsewhere within the health system (e.g., home care services, food services)
Health System Perspective • We weren’t asking the right
questions on admission to the hospital
• We could reliably identify people with cognitive dysfunction, helping the staff recognize need for “special handling”
• Staff have “ah-ha!” moments and want to change/improve care and approaches
• Need to embed in annual training to promote sustainability
Next steps
Family Caregiving Perspectives
• Identifying the special discharge needs of the patient and caregiver (both ED and In-patient)
Health System Perspective
• Nursing participation in the Duke Grand Challenge in Dementia
• Creating a multidisciplinary home health pathways of care for patients with dementia
Keys to success…
• Systems approach: – Integrating education and practice change with
administrative support
– Involving multiple professions, multiple units in organization
– Experienced consumer involvement
• Task force with eye toward sustainability: – Integration with work of patient/family advisory council
– Use of train-the–trainers approach
– Systematic spread to other parts of the organization (home care)
Challenges Remain
Family Caregiver Perspective
• Timely gero-psych access – Evaluation
– Care
• Protocol for assessment and referral
Hospital System Perspective
• Education and training in handling special situations
• Sustainability
“FirstHealth changes protocols and introduces training towards becoming
dementia friendly” The Pilot, December 12, 2013
Questions & Discussion
Biographies
• Eleanor (Ellie) McConnell, PhD, RN, GCNS-BC • Associate Professor, Duke University School of Nursing
• Director, Hartford Center of Excellence in Geriatric Nursing Excellence
• Clinical Nurse Researcher, Durham Veterans Affairs Medical Center Geriatrics Research, Education and Clinical Center (GRECC)
• Career-long interest and experience in Dementia Care
• Director of Grand Challenge in Dementia Initiative –http://cgne.nursing.duke.edu/
• Contact: [email protected], 919-684-9229
Biographies
Cheryl Batchelor, MSN, ANP-BC, NEA-BC, FACHE
Adult Nurse Practitioner, FirstHealth Transition Care Clinic
Interim Chief Nursing Officer, FirstHealth Moore Regional Hospital, 2011 -2013
Contact Information: [email protected]
910-715-3097
Biographies
• John Barrett, Family Advocate • Wife Mary Anne diagnosed with Alzheimer’s in 2005, now in
late stages of disease
• Her mantra “what can I do to help”
• Caregiver support group assistant and participant
• FirstHealth Patient Family Advisory Council Charter Member
• MooreHealth Inc. Aging Issues Committee Member
• Contact: [email protected], 910-447-9613