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Past ,Present and Future. Service development to dateOngoing projectsOur vision. To date.. Ongoing over 5 yearsShared care philosophyDesignated clinical lead Designated ward baseCollaborative working. Long Term Condition. DiagnosisMaintenanceComplexPalliative. Dementia Mapping - Comparison figures 2006-2008.
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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%)
nDementia=57(10%)
nDelerium=9(1%) Bed base 538
nTD=74(13%)
nDementia=57(10%)
nDelerium=17(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. OPMHG -Cornwall
Participation in Developing Cornwall Strategy
Regional Audit
Other Related Activities
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
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
24. 24 hour behavioural chart
25. 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.
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.