Alexandra Centre and Delirium Dementia Outreach team. Dr Lesley Young Consultant Geriatrician Sunderland Royal Hospital

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1 Alexandra Centre and Delirium Dementia Outreach team Dr Lesley Young Consultant Geriatrician Sunderland Royal Hospital

2 Background Delirium and dementia are common in acute general hospitals Poorly recognized Poorly managed 2010 National Audit of dementia Confirmed poor use of cognitive screening and lack of policy 2012 national dementia CQUIN Lever to drive change Funding for new team

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4 Summer Appointment of new team with in Elderly Care department (Delirium Dementia Outreach Team): 4x band 7 practitioners (3 senior nurses + 1 physio) ½ WTE senior pharmacist ½ band 3 admin Supervision from 1 ½ Consultant geriatricians Monitor and ensure compliance with national dementia CQUIN Proactive identification of patients with cognitive frailty at the front door Provide a hospital wide delirium service Meet policy expectations

5 Pull and push ¾ patient seen by DDOT are identified proactively from screening (PULL) Open referral system via phone call or bleep for any health care professional with concerns about delirium or dementia in a patient (PUSH)

6 DDOT review Identify nature of cognitive problem Advice on investigation and management of delirium Including medication review Advise on delirium prevention Obtain collateral history by liaising with carers Liaise with MHLT to obtain previous MH history Organise onward referral where appropriate to MHLT / CMHT / GP for formal diagnosis of dementia Send letter to GP to advise of cognitive issues during admission Arrange follow up DDOT FU clinic running since November 2014

7 Jun-13 Aug Oct Dec feb Apr June August Octob Dec. Feb. April June. Aug. Oct. Dec-15 Feb16 Apr-16 Jun-16 Aug-16 Oct-16 Dec-16 DDOT activity review New 0

8 Does it work? CQUIN target met every month since Jan 2013 Total patients for CQUIN missed achieved Find Assess Refer

9 Before-after study to evaluate DDOT 60 case notes reviewed in each group over same time period 1 year apart (Aug 2012 and Aug 2013) Inclusion criteria: consecutive non-elective admission aged 70+ years. Exclusion criteria: discharged or died with in 72 hours of admission. 100% 90% 90% 80% 70% before After 72% 69% 60% 50% 40% 30% 36% 28% 36% 30% 31% 50% 20% 10% 11% 7% 5% 0% CST O/A Repeat CST Delirium recorded O/A Delirium recorded Dx Dementia recorded Dx Ref MHLT

10 DDOT review 38% all older acute admissions reviewed by DDOT (23/61 in after cohort) Interventions included: diagnosis (n=20) collateral history (n=17) advice on investigation and management (n=20) information giving (n=19) education of staff (n=6) medication review (n=13) communication with GP (n=8) Overall DDOT review ~35% all acute admissions aged 75+

11 National Audit of dementia Case note audit - cognition NAD1 NAD2 NAD Standard MTS delirium assessment delirium reviewed MTS at discharge delirium in dx sum BPSD in dx sum

12 National audit of dementia NAD 1 NAD 2 NAD 3 LOS (days) Mortality %

13 April 2015: Alexandra centre Day therapy area for cognitively frail in-patients In reach out reach service to wards

14 Dementia friendly design, using Stirling university tool

15 Alexandra centre Patients identified by DDOT Morning and afternoon therapeutic activity sessions Patients invited to come from wards Activity + lunch or afternoon tea in social setting Sessions run by DDOT / MHLT / Action on dementia

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18 Alexandra centre Outreach to wards for patients unable to come to centre Trolley with diversional activities Ability to offer 1:1 care Assistance with meals Promoting independence De-escalation

19 Alexandra Centre Information resource for staff and carers Open access leaflet area Drop in sessions for voluntary agencies Dementia friends training

20 Outreach In reach 2015 (March-December): 2507 patients attended Alexandra centre in 4887 sessions (av 1.95/pt) 2762 patients supported on wards in 3630 sessions (av 1.3/pt) 897+ staff trained over past year 2016 (jan-november) 3212 patients attended Alexandra centre in4984 sessions ( av 1.55/pt) 3267 patients supported on wards in 4613 sessions (av 1.4/pt) >1200 staff trained in dementia / delirium

21 Staff feedback May 2015 Survey of ward sisters and matrons 58% response rate All were aware DDOT and had received input from team (56% on a daily basis) All felt it was helpful (84% very) 95% were aware of the Alexandra centre and 84% had used it (48% at least weekly) All felt it was helpful (79% very)

22 Staff feedback Subjective view of ward staff on impact of DDOT and Alexandra centre increased no impact decreased 1 to 1 nursing security falls sedation

23 Actual in patient falls reduced by 28% April/May 2015 compared to April/May Linear (2014) Linear (2015) Number of reported In- 100 Patient Falls January February March April May June July Aug Sept Oct NovemberDecember

24 mum says she loves coming to this centre Patient Feedback What a great idea. Dad enjoyed himself, as daughters we have enjoyed seeing him enjoy it Makes such a difference to those with dementia Positive feedback on BBC Radio Newcastle phone in about dementia Audrey enjoyed the dancing and would enjoy coming again I look forward to the pink ladies. I know I am in for a treat I am very happy to see Bill settle and enjoy himself

25 Challenges for the future Securing on-going funding for HELPA posts + additional ELSP Meeting NICE delirium standard (screening age group) significant workload implications Trust-wide dementia friendly environment Policy in development

26 The team Dr Lesley Young Dr Emily Lyon Matron June Lawson Specialist Pharmacist James Hogarth ELSP Chris Cairns Jackie Lynch Claire Khan Andrea Hinton Claire Boylan Leanne McGough Joanne Hume HELPAs Rachel Knowles (PT) Pat Allen (PT) Moira Kennedy Jessica Smith Emily Chapman Tanya Taylor Bev Thompson (PT)

27 Thank you Any Questions?