Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev...
-
Upload
maria-ross -
Category
Documents
-
view
224 -
download
0
Transcript of Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev...
![Page 1: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/1.jpg)
Transforming Dementia Care within Royal Cornwall
Hospital Trusts
Dr Fiona Boyd, Dementia Lead.
Bev Chapman, PCT Lead
Maggie Trevethan, Clinical Nurse Lead
![Page 2: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/2.jpg)
Past ,Present and Future Service development to date Ongoing projects Our vision
![Page 3: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/3.jpg)
To date. Ongoing over 5 years Shared care philosophy Designated clinical lead Designated ward base Collaborative working
![Page 4: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/4.jpg)
Long Term Condition Diagnosis Maintenance Complex Palliative
![Page 5: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/5.jpg)
Dementia Mapping - Comparison figures 2006-2008
Bed base 588 nTD = 69 (11%) nDementia=57(10%) nDelerium=9(1%)
Bed base 538 nTD=74(13%) nDementia=57(10%) nDelerium=17(3%)
![Page 6: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/6.jpg)
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
Correlation Between Delay in Discharge and the Presence of Disability.
y = 0.8333x
R2 = 0.7143
0
0.25
0.5
0.75
1
1.25
0 0.25 0.5 0.75 1 1.25
Disability
Delayed Discharge
![Page 7: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/7.jpg)
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.
![Page 8: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/8.jpg)
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
![Page 9: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/9.jpg)
Guidelines and PathwaysGuidelines 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
![Page 10: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/10.jpg)
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
![Page 11: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/11.jpg)
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)
![Page 12: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/12.jpg)
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)
![Page 13: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/13.jpg)
OPMHG -Cornwall Participation in Developing Cornwall
Strategy Regional Audit
Other Related Activities
![Page 14: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/14.jpg)
Joint PCT/RCHT Audit of Nursing Home Admissions
Dr Fiona Boyd
Bev Chapman
Kylie Cook
Maggie Trevethan
![Page 15: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/15.jpg)
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
![Page 16: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/16.jpg)
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
234
Reason for admission: Diagnosis (es) 1
234
Prescribing issues: Yes /NoIf yes, comment: Nursing needs: Yes/No If yes: date of request date actioned Review date Delaying factors Place of discharge Possible alternatives to admission
![Page 17: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/17.jpg)
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%
![Page 18: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/18.jpg)
Breakdown of Admission Types
Reasons for Admission to RCHT.
27%
12%
9%
8%
8%6%
30%
Infection Cardiac Falls (no
fracture) Stroke Fractures
Not Eating Other
![Page 19: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/19.jpg)
‘Other’
General breathlessness
– fatigue/exhaustion/SOB (12%) Admission from CPT Step up care (4%)
![Page 20: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/20.jpg)
Other important Findings Palliative 29 (32%) Treatment feasible in the Home 64 (70%)
![Page 21: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/21.jpg)
What’s 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
![Page 22: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/22.jpg)
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
![Page 23: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/23.jpg)
No
Cognitive deficit identified: Chronic / Acute on Chronic / Acute
Suspected Dementia
History
Examination
Investigations
Cognitive Assessment
Identify and Treat reversible factors
Contact Eldercare team for definite diagnosis
Diagnosis Dementia Known
Check who made diagnosis and date
No Psychiatric input needed discharge as per medical needs
Is deterioration rapid and unexplained?
Does history include:Deteriorating cognitionChallenging behaviourComplex discharge
Yes
No
Yes
Nurse in a Calm Quiet Environment
Any psychiatric concerns?Risk to others / self?
No
Contact eldercare psychiatric liaison team via switchboardIf unavailable contact on call mental health services on ext 1300Consider using section 5(2) Mental Health Act if necessaryUsing monitoring tools (see section 4) and sedate as necessary
Use sedation if necessary. Adjust dose according to body mass and renal function. Review daily. Only if severe distress or there is an immediate risk of harm to the person with dementia or to others.
Yes
For details of above flow chart see following page
![Page 24: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/24.jpg)
24 hour behavioural chart
Time 24hrs
Agitation/Restlessness
Violence/Aggression
Care Refusal
Wandering
Fall
Pain
Sleep Disturbance
Settled
![Page 25: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/25.jpg)
Guidelines : Pain > 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.
![Page 26: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/26.jpg)
Patients with Dementia
Experience communication difficulties Lack understanding Interpret and express their pain in ways
![Page 27: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/27.jpg)
PAINADItems* 0 1 2 S
core
Breathing independent of vocalization
Normal Occasional laboured breathing. Short period of hyperventilation.
Noisy laboured breathing. Long period of hyperventilation. Cheyne-Stokes respirations.
Negative vocalization
None Occasional moan or groan. Low-level speech with a negative or disapproving quality.
Repeated troubled calling out. Loud moaning or groaning. Crying.
Facial expression
Smiling or inexpressive
Sad. Frightened. Frown. Facial grimacing.
Body language Relaxed Tense. Distressed pacing. Fidgeting.
Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.
Consolability No need to console
Distracted or reassured by voice or touch.
Unable to console, distract or reassure.
Total**
![Page 28: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/28.jpg)
Guidelines: Palliative Understand the drivers to improving end of
life care for those with dementia
Identifying terminal phase care
Practical measures (care pathways)
![Page 29: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/29.jpg)
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.
![Page 30: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/30.jpg)
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.
![Page 31: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/31.jpg)
What on For 2010
Re-launch –Let’s Respect campaign in collaboration with ‘Worried About you Memory’
What’s Your Story- Life Story Books Education -Modular programme (In
collaboration with Learning Development) Completion of RCHT Dementia Strategy and
Business Plan
![Page 32: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/32.jpg)
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
![Page 33: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/33.jpg)
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
![Page 34: Transforming Dementia Care within Royal Cornwall Hospital Trusts Dr Fiona Boyd, Dementia Lead. Bev Chapman, PCT Lead Maggie Trevethan, Clinical Nurse Lead.](https://reader036.fdocuments.in/reader036/viewer/2022062314/56649e225503460f94b0f96f/html5/thumbnails/34.jpg)
The Royal Cornwall Hospital
People with passion and vision.