THINK FRAILTY the journey continues
June Wylie
Time Item Lead 13.30 Welcome June Wylie (Chair) 13.35 Overview of OPAC work stream and progress to date Penny Bond 13.40 Patient/Family/Staff experience Rowan Wallace 13.55 Engagement with families. Patient, family & staff experience (from ASSET team and ACE nurses) Trudi Marshall 14.10 Panel Discussion Trudie Marshall/Brian Mcgurn/ James MacWilliams/Dianne Coleman/Rowan Wallace/Lesley Herd 14.40 Close June Wylie (Chair)
Penny Bond
Think frailty - the journey continues... Improving care for older people in acute care
Frail older people Why Frailty? Have physical, cognitive and functional impairments Are often admitted with falls/immobility/ confusion due to significant underlying medical problems High risk of healthcare associated infection, delirium and under-nutrition in hospital
Tools being tested: Locally adapted frailty triage tools and criteria Aim: 95% of frail patients (within test sites) have access to comprehensive geriatric assessment within 24 hours of admission, by March 2014 Impact: Comprehensive Geriatric Assessment carried out within 24 hours of admission Reduction in length of stay in hospital Reduction in boarding/hospital moves Improved patient experience
Key messages Cross-sector working & integration Reduce LOS; Prevent unnecessary admission Dedicated unit for frail elderly people with early appropriate treatment/discharge share comprehensive geriatric assessment team work from acute settings to community hospitals Blurring of boundaries - roles Identification of frail older people is critical Right patient, right bed, right time frame helpful to learn from each other to improve care delivery Zero tolerance for boarding Engaging families & carers
Focus on frailty
@opachis www.improvingcareforolderpeople.scot.nhs.uk
Rowan Wallace
Patient & Staff experience Frail Older Person s Pathway NHS Ayrshire and Arran
Pilot period Aim; to focus on the pathway starting in A&E and improve the patient experience for people over 65 Pre pilot discussions with staff and patients/families What is important to the individual? What makes a difference? What needs to happen to demonstrate that the project is an improvement?
A&E environment The challenges Difficult to predict when might be the best time to speak to patients Key stages of the journey Unable to rely on questions that have a basis in comparisons Measuring qualitative outcomes
What we did Conversation rather than interviews Discussions with staff Emotion words Defining what is important to the individual
How we did it Observation And Conversations Patient/carer /family stories Patient Staff /Team conversations /comments
Emotional map - Staff Ward CNs to spend time in ED Had time in wards to plan discharges Feeling tired but keen to get going Admin co-ordinators role vital in identifying issues with process Best shift ever in 3E Saw everyone that we needed to even though went past cut off time Much busier day but we managed Overall busy day 9 empty beds in 3E Red dot process Feeling that it wasn t as slick today to begin with Wards & CDU asked to be more embedded in pathway
Emotional Map - Patients Scared that I wouldn t get home Real benefit that my father didn t need to be admitted A&E More than I expected gold star experience! (interview in CDU) 10 out of 10, first class service. Nothing to say other than positive things Ward Alternative to admission I was told that I was going to a 72 hour bed that s a relief to know that I won t be in here for long Going to a step down bed, not sure what that means Anxious A&E was an experience didn t like how busy it was. Great that my husband could stay with me Initially I was concerned that my mother was going home from A&E but didn t realise what could be done to help her at home Home Great that I am back home, no complaints
Reshaping Care Feedback from Scottish Government public engagement events shows that people want to be able to live in their own homes for as long as possible People want services to be personalised and delivered in a joined up way that offers continuity and meets their needs (COSLA, NHS, Scottish Government 2011-2021)
Mr Mc 72 years old, lives at home with son, who works shifts. His other son lives locally but works away from home for much of the week. Neighbour pops in a few times during the day. Went to pick up newspaper from behind front door, as he does every day. Not sure what happened but fell and thought I had broken my leg Ambulance called Brought to A&E FOPpathway
Mr Mc contd. Examined, X-ray, No fracture, Pain control Step down bed Visited to discuss experience I am pleased that I am here and not in Hospital. I know that I am not ready to go home and don t want to be a burden on my son. I am in so much pain and don t want to get up and try moving around. The Doctor explained that it would be better for me to be here and not in the hospital and that it was a shorter term thing, they expect me to be going back home...i m delighted to hear that, I m too young to be looked after and still want to live in my own house.
Mr Mc contd. Visit at Home I am feeling much better and happy to be back at home. The whole experience was good, I enjoyed being in the step down place, they treated me so well and the Physio helped me to get up and moving again. I didn t think that I would be able to do it but she told me what to do and helped me, if I was left on my own, I wouldn t have even tried! I was worried that my son would have to give up work or I would end up in a home and that would be me... I have my dog for company and can see to him myself, I can t walk him but can do everything else
Lessons learned People can be worried to give their opinions whilst still in Hospital Family and Carers are often more outspoken Generally the care and treatment given is appreciated and there is a sympathy towards the staff in relation to workload Service and patient priorities can differ Timing of the discussions is important
Trudi Marshall
Diane Coleman Trudi Marshall Lesley Herd James Brian McGurn McWilliams Rowan Wallace