London Acute Trust progress on standards of care for people with dementia

Transcription

1 London Acute progress on standards of care for people with dementia In 2010 all London Acute s took part in the Royal College of Psychiatrists National Audit of Dementia. The results of each trust s assessment against standards of governance and care for people with dementia receiving treatment in hospital have been published for the first time on myhealthlondon. For further information on the audit, and the 2012 repeat, please go to: In July 2012, Andy Mitchell, Medical Director for London wrote to all London Acute s to request permission to publish the 2010 audit results, and also to request that trusts provide a summary of what action and progress has been taken since the first audit. The response of trusts to this request is in the table below: London Acute Barking, Havering And Redbridge s NHS Name Summary of progress on dementia care since 2010 (as at July 2012) King George Queen's Governance: Acute elderly units for both sites, this allows better multidisciplinary working for all older people including those with dementia. Delivery of care: Dementia/delirium pathway launched. All emergency admissions >65 screened with AMTS and patients <8/10 are assessed for delirium with the CAM. Mental Health Needs: Policy for BPSD has been written and been incorporated into the Dementia/Delirium pathway. Discharge Policy: We ensure that discharge planning begins within 24hrs of admission and that patients with dementia are only moved during the day unless it is for reasons pertaining to their care and treatment. Information: This is me document being used- to collect information pertinent to the person caring for the patient with dementia. Recognition of dementia: Due to launch the butterfly scheme ( later this year. Training, Learning and Development: Introduced dementia training for Drs/Nurses/HCA/Therapy staff. Taken up places for Dementia Train the trainer scheme offered by NHS London Specific resources supporting people with dementia: Although we have discharge co-ordinators, we do not have a named person for dementia, this is something we have addressed in our dementia strategy. Liaison Psychiatry: Collaborative Care team at Queen s (old age psychiatry) has been formed helping us to improve in this area.

2 Barnet And Chase Farm s NHS Barts Healthcare NHS Barnet General Chase Farm The Royal London, Whitechapel Following the release of the report from the national audit of dementia we have implemented a significant number of improvements. The can currently collects data on admission rates, falls, treatment and discharges and can identify patients with dementia within this dataset. Skin bundle, risk assessments, pain scores are completed for all inpatients. Assessments are audited and reviewed at our weekly nurse indicator meeting. The Butterfly scheme has been rolled out trust wide and Protected meal times are in place the releasing time to care meal module has been implemented along with the red tray system. In addition we have introduced green drinking glasses and cups for patients with dementia.. A Dementia Strategy Steering group is in place and is chaired by an executive director, with a lead consultant and nurse in place. It includes agencies such as the Alzheimer s society and also has relative representation. There is currently a non Executive Director Lead for patient experience & quality which includes dementia care.there are dementia/dignity Champions on each ward with monthly meetings in place. The Dementia care pathway and medical referral pathway are in place. NICE guidance is in use. The Admission and Discharge policy covers patients with Dementia as well as other vulnerable groups. There is also additional guidance available on the Intranet There is an environment project in partnership with the estates & facilities contractor that is focused on improving the physical environment for patient with dementia which includes the repainting of bathroom doors and making bed areas dementia friendly. Bespoke Training has been implemented; a two day training course for professional staff and a one day course for ancillary staff. Dementia Training has been implemented as part of the patient Safety days and an e-learning training package has also been rolled out. Since the last National Dementia Audit the has been developing a dementia pathway and this is to be launched in the next few months. Cognitive screening of patients admitted to the has improved. A dementia formulary has been agreed and will be placed on the intranet so that it is available to all staff. A new care plan to meet the needs of patients with dementia is being introduced. There has been dementia awareness training for all staff groups with regular nursing training sessions and the topic has been included in all medical induction programmes Some of the work planned has been delayed by the merger of three s (Barts and the London, Whipps Cross and Newham) which took place in April 2012 as we aim to have common guidelines across all the merged sites.

3 Newham A number of improvements have been made at Newham hospital to improve the experience of people with dementia and their carers: The Older People s Liaison service established - includes consultant nurse for older people, older people s mental health nurse, dementia care advisor, specialist occupational therapist, sessions from a consultant old age psychiatrist and a geriatrician. They support staff caring for people with dementia ensuring needs are understood and met; support carers ensuring their needs are assessed and refer on to community dementia support services. Also provides in-reach from the diagnostic memory clinic to improve assessment and diagnosis of dementia. Improved documentation ensures staff have easy access to diagnosis information and care plan. Capital bids for environmental improvements have been made and collaboration with local colleges to provide materials for engagement and stimulation for people with dementia whilst in hospital. As a newly merged trust work is underway to develop care pathways for people with dementia across the trust and development of a system to enable all staff to identify when a patient has dementia. Further weekly training sessions to include nutrition, delirium, challenging behaviour in addition to monthly training & induction awareness for all clinical staff. Whipps Cross The improvements achieved at Whipps Cross Appointment of Nurse Consultant in Dementia / Delirium Looking at the environment (Dementia friendly) and making improvements. e.g red door frames, red toilet seats, clocks for people to see in bays. Liaising with the Estate Department in relation to the development of the New 70 bedded MEC which will incorporate a Delirium friendly bay to minimise distress suffered by patients. There have been some delays to new developments that are due to the merger of three trusts to create the new Barts health. This is to ensure that there is consistency on all three sites. There is currently a lot of work in progress. This is reflected in the improvements of the increase in the recording of the AMT in the first 24hrs of a patient s stay this has increased to 50% it has previously been as low as 10%. There is Dementia Awareness training offered to all new starters at induction. There are different training packages being developed to meet the needs of different staff groups including the portering and domestic staff which are supplied by outside contractors. Chelsea And Westminster NHS Foundation Chelsea And Westminster Our clerking pro forma on the Acute Assessment Unit incorporates an abbreviated mental test score. Dementia screening for over 75s has been launched on the acute assessment unit. A referral pathway for patients with cognitive impairment has been set up.

4 Ealing NHS Epsom And St Helier s NHS Guy's & St Thomas' NHS Foundation Homerton NHS Foundation Ealing Epsom General St Helier St Thomas' Homerton NHS Improving Dementia Care at Ealing NHS Following the Royal College of Psychiatrists audit in 2010 the has worked to improve the assessment and care provided to patients presenting with dementia and cognitive impairment. The hospital has introduced dementia screening of all patients admitted over the age of 65. Since April the hospital has a seven day a week Liaison Psychiatry service who are based on site. This service is working with hospital clinical staff in the management of patients with dementia... To support patients and families the hospital is appointing a Nurse Specialist in Dementia and introducing the This Is Me Care plan for all admitted patients with a diagnosis of dementia... The hospital is supported by a Dementia Concern Advocate who works closely with patients and families. Care of patients with dementia is part of all staff induction programmes. staff are currently undertaking dedicated training facilitated through NHS London and this will be rolled out to clinical teams in the months ahead. The hospital is working with Commissioners, Social Care and Voluntary agencies on developing and improving the whole system care of dementia suffers. Governance -reporting structures to the Board are through the s Safeguarding Adults at Risk Committee which include specific Dementia related issues. Delivery of care - The modernisation initiative led on many areas of improvement for patients with dementia requiring palliative care. This includes pain recognition and management. We have also implemented the AMBER care pathway. Mental health needs screening and assessment of patients over the age of 75 and referral to specialist services is a priority as part of the National Dementia CQUIN. Information since 2010 we have introduced the This is me document for patients with dementia and have built on this to introduce admission packs for staff to use when admitting a patient with a dementia illness. Recognition of dementia We have adopted a Forget-me-Not model of care for dementia awareness across the. Training, Learning & Development we have introduced a mandatory 1 hour face to face dementia awareness training programme for all staff across the organisation. A one day programme of enhanced teaching is also available for staff. We are committed to a strong dementia training programme as part of the London Dementia CQUIN.

5 Imperial College Healthcare NHS King's College NHS Foundation Kingston NHS Lewisham NHS Charing Cross Hammersmith St Mary's Kings College Kingston Lewisham Improvements in dementia care that have been implemented or are in the process of being implemented throughout the : A policy for dementia - currently ratified within Medicine Clinical Programme Group (CPG) and subject to wider consultation in other CPG's pending full ratification An identified lead clinician for dementia. Better routine cognitive testing of all patients >65. Clinical guidelines for the management of dementia and delirium. Reduction in antipsychotic use. Mandatory awareness training in dementia for all new starters in the. A rolling programme of education and training in dementia for healthcare professionals. Establishing pathways for dementia linked to the NWL Integrated Care Pilot. Enhanced liaison psychiatry provision. Enhanced nutritional screening and reporting of malnourishment. Kingston acknowledges that there are gaps in dementia service provision and that the current national audit will still show some deficiencies. However, a Dementia and Delirium Group has recently been set up with the aim of closing these gaps by undertaking a comprehensive work programme. By the end of March 2013, the will have explicit care pathways in place for the management of patients with dementia. The work programme is led by the Consultant Dementia Lead with support from a multidisciplinary team and the is appointing a dedicated dementia specialist nurse. The s dementia work programme will ensure that all patients aged 65+ are asked the national dementia question* and that all patients at risk of dementia are then fully assessed and referred as appropriate. The 8 things about me programme is being piloted. This will ensure that each patient s preferences are known to all staff looking after a person with dementia. The ward environment is being assessed to ensure it meets the needs of patients with dementia. The junior doctors training programme includes dementia screening and referral and audits will be carried out as part of our CQUIN to ensure care for people with dementia continues to improve. *Have you become more forgetful in the last 12 months so that it has significantly affected your life? National Dementia Audit Statement The has developed a Dementia Pathway based on the NHS London Dementia Strategy. The pathway covers all aspects for managing a patient with suspected Dementia, and provides guidance to practitioners for an unplanned admission, or a planned admission for elective surgery, or treatment not directly associated with cognitive impairment or dementia. The pathway addresses the following:

6 Mayday Healthcare NHS North Middlesex NHS Mayday (now Croydon ) North Middlesex NHS High quality physical healthcare based on good information and a strong clinical evidence base. A dignified and person-centred experience. An experience that minimises distress and ensures the patient is discharged without losing more functionality. A reduced length of stay and improved satisfaction from the discharge process. Increased numbers of patients being screened for dementia. Use of dementia passports, to improve in-hospital care of patients with dementia. Use of patient identifiers to highlight to staff patients with dementia who will need greater supervision and help. Review of all patients with dementia who are admitted on antipsychotics, by liaison psychiatry. Increased training: all doctors receive training on Dementia at induction. All inpatient ward staff have been trained in Dementia awareness. Instituted Dementia Champions who lead on caring for patients with dementia, and staff education. Improvements made since this audit was carried out include: Dementia pathway developed along with with guidelines for the management of patients with delirium Clerking proforma developed to include assessments for cognitive function delirium and social support needs. This proforma adopted by general medicine and elderly care teams. Nursing admission paperwork revised to ensure awareness of dementia, signs of delirium, social information, nutritional status and falls risk. Training programme for nurses and doctors and dementia awareness at induction for all staff. Oversight of the dementia action plan by executive directors at quarterly meetings. Monitoring of improvements through local CQUIN. Planned developments in 2012 include: Appointment of a dementia specialist nurse Patient and carer focus group Introduction of dementia passport onto the acute wards Progress against Dementia CQUIN Use of the Abbreviated Mental Test Score (AMTS) as the initial assessment in all specialties receiving adult patients.

7 Clear guidance has been developed for triggers for more detailed assessment using the Mini Mental State Examination (MMSE). There is an alert on the s Patient Administration System (PAS) identifying those patients who attend the hospital with an existing diagnosis of dementia. Teleconference involving Mental Health Services and Acute to discuss patients with both existing and potential diagnosis of dementia enabling appropriate referral treatment and care. Improved data collection for readmissions and discharges. Delirium Pathway Delirium pathway in place. Training for primarily medical staff incorporated in the induction programme. Implementation of Confusion Assessment Method (CAM) to support detection of delirium, a sticker has also been developed to improve communication and alert staff to the risk of delirium. Roll out of delirium risk assessment to include pre-assessment clinics for surgery and any other relevant services In patient care Development and implementation of dementia care bundle for use on acute adult wards. This care bundle includes: Explanation of care bundle 10 Important things about me Record of behaviour that challenges (this has been modified to include potential triggers and relieving factors) Communication sheet for carers and or patients to write any concerns or questions for care staff and for care staff to provide a written response. Information on Carers Passport All documentation has now been received from the printers and this initiative will be rolled out across the over the coming 6 months Training 1 day understanding Dementia workshop in partnership with Dementia UK. This is open to all staff groups. 1 day Advanced Communication Skills in Dementia. In partnership with Dementia UK. This is aimed at registered staff at present and those staff who have undertaken the Understanding Dementia or similar training. Bite sized Dementia Nuggets programme Multi disciplinary and included 5 sessions.

8 North West London s NHS Royal Free Hampstead NHS Central Middlesex Northwick Park & St Mark's s Royal Free Bite sized Dementia Nuggets programme for support staff incorporating domestic, portering, hostess and security staff. Three members of the Dementia Board have attended the NHS London Train the Trainer modules to support increased in house delivery of training Requirements for Adult safeguarding, mental capacity and Deprivation of Liberty training are delivered and monitored through the s mandatory training programme. Audit and Research National Audit for Dementia The Behaviour and Pain in Dementia Study (BePAID) Working towards a dementia friendly environment Both Acute Elderly Care wards have been refurbished to include different coloured bays to help way finding 40 large calendar clocks have been purchased with the support of the League of Friends to improve orientation to day, date & time The has invested in two staff attending the Kings Fund Enhancing the Healing Environment Dementia Champions

9 South London Healthcare NHS St George's Healthcare NHS Princess Royal Univ. Queen Elizabeth Queen Mary's St George's The 3 hospitals participated in the national dementia audit in The audit found a number of areas where care for patients with dementia could be improved. The dementia strategy group reviewed the findings of the audit and has implemented a detailed plan to improve patient care in the following areas led by senior medical and nursing staff: Specialist dementia services have been developed on the Princess Royal site, and surgical wards one and two are being sponsored by the Mayor of Bromley this year to make the unit more conducive for patients with dementia. Sisters and staff on ward 15 at Queen Elizabeth have recently been awarded a dignity award through Greenwich Council to recognise the work they are doing to improve the care that patients with dementia receive on their wards. The butterfly scheme which provides staff with a simple way of identifying and meeting the needs of patients with dementia is being launched across the. Dementia UK are providing dementia training for staff. Lead nurses have been trained and are cascading the training on all sites as part of the ongoing training programme. Further training is being developed with the of Greenwich. Staff awareness of dementia has been raised through the implementation of the Royal College of Nursing This is me tool; a quarterly dementia newsletter; and the display of flyers and posters across the. There is a strong focus on the management of nutrition for patients with dementia including an Academic Multi-Disciplinary Session on feeding in Dementia. Risk feeding protocols and a nutritional pathway have been implemented. Our focus on falls prevention is working with patients over 70 who are at a greater risk of falling through the early identification of risk factors for falling. We are working closely with our mental health provider and a new improved service from psycho-geriatricians has recently commenced; a mental health liaison nurse is based at Queen Elizabeth, with a similar role being piloted at Princess Royal. Care pathways for patients with dementia and delirium are being developed. Information leaflets have been developed for patients and their carers. Screening and risk assessment of patients with dementia is being introduced as part of the national CQUIN scheme. The use of anti-psychotics has been audited to ensure it is consistent with best practice Since these data were compiled in 2010, St George s Healthcare NHS has put in place several measures to improve care for people with dementia.

10 The Hillingdon NHS The Hillingdon A dementia strategy group, chaired by the dementia clinical lead, meets every eight weeks to set the s strategy for improving dementia care and to review progress. The group s membership is drawn from across the organisation and includes representatives of partner agencies such as Wandsworth social services and the Alzheimer s Society. The group reports to the Patient Issues Committee, chaired by the Director of Nursing/Chief Operating Officer, and through this body, to the board. Developments include a clinical guideline for management of patients with dementia, adoption of the Butterfly scheme (a dementia recognition and care response scheme), creating dementia champions, inclusion of dementia awareness in corporate induction and the establishment of a dementia training sub-group to draw up specific requirements for each professional group. The dementia strategy group monitors complaints, enquiries to PALS and incident reports where dementia is a theme. A systematic approach to dementia assessment in older people is being rolled out this year as part of the national dementia CQUIN. Training Dementia Working Group established 2010 they continue to meet to work to improve the quality of care for Dementia patients. Care pathway for patients with dementia is under development. Cognitive assessment protocol introduced for inpatients. 4 point cognitive screening tool introduced in A&E. Ortho-geriatric clerking booklet includes AMTS/CAM score and Abbey Pain Score. Challenging Behaviour policy written and approved. Environment is being changed, with the purchase of Calendar Clocks to improve orientation, updated toilet signs and the use of coloured cups. Prompt added to the e-discharge system for patients with a mental health diagnosis. A&E paperwork altered to include a flag to the GP of any cognitive deficit detected. This is Me paperwork trialled and used in some wards. This helps gather better information about patients and improves communication with carers. As part of a pilot scheme, Psychiatric liaison team are available for all inpatients with mental health needs and to review any patient on anti-psychotic medication. Sterling course commissioned to train Dementia Champions Dementia champions delivering local dementia training Multi-disciplinary training commissioned from Bucks New Foundation training for doctors

11 The Whittington NHS College London NHS West Middlesex NHS The Whittington College London West Middlesex Dementia awareness training within Corporate Induction

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