Presenter: Janet Lloyd Hospital Name: Caulfield Hospital

1. The Health Roundtable New Zealand Prevention of Functional Decline for Older People in Hospital- Pilot of an Innovative of Model of Care(COAG Long Stay Older Patient Initiative) Future Role of Allied Health Presenter: Janet Lloyd Hospital Name: Caulfield Hospital Key contact for this project ( name & details): Lisa Gill, Manager, Clinical Innovation and Interdisciplinary ProjectsBee Cochran, Project Coordinator, Clinical Innovation and Interdisciplinary Projects

2. Key Problem • People >70yo (13% of Victorian population) use >46% of bed days • The population is ageing • 35-50% of older patients experience functional decline during a hospital admission • Functional decline can occur as early as day 2 of hospital admission • In 30% of these patients, functional decline is unrelated to their primary diagnosis

3. Key Strategies / Ideas Implemented • Target ward – acute care of the elderly/general medical ward • Steering group - senior staff all disciplines • Introductory Interdisciplinary Workshops (Dec 08 –March 09) • 98% of all ward clinical staff attended • Education about functional decline and planning of ward based interventions • Functional Conditioning Program (FCP) • Functional Conditioning Assistants (FCA) • Newsletter and other communication strategies • Education sessions on specific care domains • eg continence, nutrition, depression, delirium, dementia

4. Functional Conditioning Assistant (FCA) • Role competency standards development • All disciplines inputted into development of standards and assessment of competence • Position description • Ward based Allied Health Assistants • Operational report to NUM • Professional link to relevant disciplines ( mainly OT, PT and Nutrition) • Recruitment process • Extensive orientation & on the job training program • Regular FCA and FCP meetings

5. Timelines & Resources • Extensive consultation with key stakeholders over a period of 2 months before implementation • Phasing of implementation over 18 months • Main resources • Two part time, 7 day per week /1.37 EFT FCAs initially • soon to be reduced to one FCA , 5 days per week 0.79 EFT • Project Coordinator • Additional staff time and commitment to planning, education and practice changes • Small budget allocation for equipment and ward set up changes

6. Key Outcomes Achieved • Set of performance indicators required by Department of Health (DOH) as part of the project (mostly domain based, clinical file audits) • majority have shown improvements • Staff knowledge of prevention of functional decline survey • baseline and post survey indicate substantial improvements • Focus groups • qualitative data very positive especially about FCA role • Other local indicators eg. patients dressed, sitting out of bed • Patient experience survey pilot – positive feedback • External DOH evaluation still to occur

7. Lessons Learnt • Don’t underestimate the time required for effective stakeholder consultation • Need to hear people’s anxieties about introducing a new model and be patient, responsive and reassuring • Get their ideas about how to make it work • Reassurance that there is a mechanism for feedback and changes can be made as you progress • Importance of local and hospital wide communication