ACUTE DEMENTIA CARE STRATEGY. Research Days 15 November 2012

Transcription

1 ACUTE DEMENTIA CARE STRATEGY Research Days 15 November 2012

2 Background Acute care settings are not prepared for the rising tide of patients with dementia Patients with dementia have worse outcomes and prolonged stays in acute care compared to those with intact cognition More research is needed to address dementia impact in acute care Stakeholder recommendations: i. Need for person-centered care ii. Improvements in universal acute care dementia education

3 PROGRAM GOALS i. To improve the quality of care for all clients with dementia while receiving acute care services in Northern Health hospitals ii. Increasing staffs level of dementia education, including training specifically related to preventing and managing behavioural and psychological symptoms of dementia and managing delirium

4 PROGRAM COMPOSITION E-Learning (1.5 hrs) i. Part 1: Foundational Information ii. Part 2: Sustaining Quality of Care Face-to-face Learning (2.5 hrs) i. Part 1: Managing and Accommodating Behavioural and Psychological Symptoms of ii. Dementia Part 2: Delirium Management

5 MENTOR TRAINING Videoconference training to 40 mentors in September acute care sites participating Goals of training: i. ~600 current employees by September 2013 ii. All new clinical staff (on targeted units) UHNBC: FMU only, Fort St. John: Inpatient Unit only Currently not participating: Burns Lake, Prince Rupert, QCI, Masset

6 FRAMEWORK Elderly Services Program + Project Coordinator (Sasha Wade) Mentor Administrator Staff Face-to-Face Training Staff Clinical Support Mentor Support

7 LEARNING OBJECTIVES Understand basic information about dementia, personcentred care, and clinical best practices Learn to interpret, mitigate when required, and support behavioural and psychological symptoms of dementia in an acute care setting Increase awareness and understanding of delirium management and its relationship with dementia Learn about corresponding clinical tools that can be utilized in an acute care setting

8 PRE-EDUCATION EVALUATION Evaluation results: i. Low awareness (31%) and utilization (18%) of Northern Health s Clinical Practice Guidelines for Older Adults ii. iii. Only 14% had carried out a formal delirium assessment Only 16% had used a behavioural tracking tool

9 POST-EDUCATION EVALUATION Two aspects were evaluated: i. Perceived vs. real dementia and delirium knowledge ii. Satisfaction and confidence in skills and knowledge around dementia and delirium

10 POST-EDUCATION EVALUATION Evaluation results: All (100%) of participants reported that they would recommend the training to colleagues i. (only 20% were satisfied with the level of dementia ii. knowledge of their colleagues) (only 52% agreed/strongly agreed that patients in the hospital receive patient-centered care) 81-84% of participants agreed that the three tools were feasible to start utilizing in an acute care setting once staff became educated about their use.

11 OUTCOME MEASURES NH s Health Information Management Service Project specific Discharge Abstract Database codes added: i. > age 65 and query/diagnosed dementia or delirium? ii. iii. iv. Use of benzodiazepines or antipsychotics Use of physical restraints Use of 3 clinical tools Behavior Log: Dementia Observation System Tool My Daily Care Routine: Person centered care Confusion Assessment Method Regular performance reporting to sites planned

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15 References Smetanin, P., Kobak, P., Briante, C., Stiff, D., Sherman, G., and Ahmad, S., Rising Tide: The Impact of Dementia in British Columbia 2008 to 2038, 2009, RiskAnalytica. BC Dementia Education Framework, 2009, Fraser Health Authority. BC Dementia Service Framework, 2007, Provincial Dementia Service Framework Working Group. Dementia: A Public Health Priority, 2012, World Health Organization. Dr. Donnelly, M., Dr. McElhaney, J., and Carr, M., Improving BC's Care for Persons with Dementia in Emergency Departments and Acute Care Hospitals: Findings and Recommendations, MacCourt, P., The Dementia Policy Lens Toolkit, 2009: Victoria, BC. Morrison, R.S. and A.L. Siu, Survival in end-stage dementia following acute illness. JAMA, (1): p Sampson, E.L., et al., Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry, (1): p