12000  Trained  Sharing  Event  –  19th  March  2014    

Innovations  in  Dementia  Care  –  Table  presentations  

 Title:  Delivering  Dignity  through  Empowered  leadership  

Barts  Health  has  14  older  people’s  wards  across  four  hospital  sites,  and  despite  there  being  a  sound  evidence  base  for  what  constitutes  compassionate,  dignified,  relationship  centered  care  for  older  people,  the  feedback  from  our  older  people's  services  showed  that  we  were  falling  short  of  this  on  many  occasions.  A  unique  and  innovative  solution  to  address  these  concerns  was  required.  Learning  from  previous  projects  around  the  country  aimed  at  improving  dignity  and  compassion  in  care  (Nicholson  et  al  2010,  Patterson  et  al  2011),  Barts  Health  invested  in  an  educational  project  that  would  enable  whole  ward  teams  to  learn  and  develop  together.    A  shadow  team  was  recruited  to  replace  each  ward  team  as  they  attended  a  week-­‐long  development  programme.  The  programme  included  individual  and  team  assessment  and  needs  review,  alongside  developing  the  knowledge  base  of  the  team  using  Nolan's  six  senses  framework  and  the  BPOP  guidelines  as  a  foundation  for  practice.  Ward  teams  were  empowered  to  identify  how  their  care  and  communication  could  improve  and  supported  to  develop  action  plans  to  make  immediate  changes  to  improve  the  quality  of  the  care  they  provided  to  their  patients,  visitors  and  each  other.  A  robust  support  and  sustain  framework  has  been  developed  to  ensure  ward  teams  are  able  to  put  their  action  plans  into  practice  and  enable  teams  to  develop  ways  to  continually  review  and  improve  care.  

Presenter:  Michelle  Parker  michelle.parker@bartshealth.nhs.uk  

   

 

 

 

Title:  The  Compassion  Programme  -­‐Care  of  memory  problems  in  advanced  stages:  improving  our  knowledge.  

Funders:  Marie  Curie  Cancer  Care.    CI  Dr  Louise  Jones;  PI  Dr  Elizabeth  Sampson,  Marie  Curie  Palliative  Care  Research  Unit,  Division  of  Psychiatry.  

 

This  is  a  3-­‐year  research  programme.  Work-­‐stream  1:  Defining  the  health  and  social  care  needs  of  people  with  advanced  dementia  and  their  caregivers.  A  prospective  cohort  study  of  people  with  dementia  FAST  Stage  7a  from  care  homes  and  the  community  across  London,  and  their  family  carers.  Assessments  monthly  for  up  to  9  months  using  standardised  tools.    Work-­‐stream  2:  Workshops  and  interviews  with  health  and  social  care  professionals  in  4  UK  countries  to  understand  the  components  for  a  complex  intervention  to  improve  care.  This  includes  data  from  people  with  early  stage  dementia  and  family  carers  of  people  with  advanced  dementia.  The  draft  intervention  was  refined  using  the  RAND  process  and  a  final  version  developed  for  piloting  as  a  model  of  enhanced  integrated  care.    Work-­‐stream  3:  A  pilot  study  of  the  intervention  following  implementation  research  guidance.  After  ethical  approvals,  data  collection  will  commence  in  spring  2014  in  two  North  London  CCGs.      

Presenters:  Margaret  Elliott,  margaret.elliott@ucl.ac.uk  

           Bridget  Candy  b.candy@ucl.ac.uk  

 

Title:  The  Behaviour  and  Pain  in  Dementia  (BePAID)  Study  

There  have  been  no  UK  studies  on  how  common  BPSD  and  pain  are  in  people  with  dementia  on  acute  medical  wards  and  how  these  impact  on  patients,  carers,  and  costs  to  the  NHS.  We  studied  230  people  with  dementia  who  had  unplanned  medical  admissions  and  measured  how  commonly  BPSD  and  pain  occurred.  We  found  that  ¾  had  BPSD  at  some  time  during  admission,  mainly  agitation  and  aggression.  BPSD  were  associated  with  adverse  events  whilst  in  hospital  (i.e.  falls)  and  poorer  quality  of  hospital  care.  Staff  used  sedative  and  neuroleptic  drugs  to  manage  these  and  not  other  behavioural  techniques  such  as  reassurance  or  diversion.  The  use  of  these  drugs  was  associated  with  higher  mortality.  Only  half  of  our  study  participants  could  use  the  FACES  pain  scale  (a  pain  tool  commonly  used  in  the  NHS).  An  observational  pain  tool  found  that  over  one  third  had  pain  during  a  care  task  or  on  movement.  There  was  a  link  between  BPSD  (particularly  aggression)  and  pain.    

 

Presenter:  Kathryn  Lord  K.lord@ucl.ac.uk

 

 

 

 

 

 

 

 

Title:  The  SHINE  Discharge  Project,  Royal  Free  

A   pro-­‐active   case   management   model   for   discharging   patients   who   have   dementia   or   a   suspected   diagnosis   of  dementia.   It  provides  a  bespoke,  personalised  service  where  a  discharge  plan   is  developed  in  partnership  with  the  patient,  the  carer  and  the  multi-­‐disciplinary  hospital  team  in  order  to  improve  the  quality  of  discharge  planning  for  patients  admitted  from  their  own  home.  

The   project   signposts   and   co-­‐ordinates   a   developing   community   based   infrastructure   to   ensure   that   the   whole  process  is  supported,  sustainable,  dignified  and  feels  safe  for  the  person  with  dementia  and  the  carer.  

It   is  managed   by   a   specialist   dementia  Occupational   Therapist  who   is   the   single   point   of   contact   for   the   patient,  family   and   staff   throughout   the   admission   and   discharge   process.   The   service   provides   assessment   of   need   and  inpatient  therapy  alongside  discharge  co-­‐ordination  and  follow  up  post  discharge.    

 

Presenters:  Danielle  Wilde,  Dementia  Specialist  OT.    Email:  Danielle.wilde@nhs.net  

 Becky  Lambert,  Dementia  Lead,  Royal  Free  Hospital.  Email:  becky.lambert@nhs.net  

 

Title:  Involving  people  with  dementia  in  service  development,  Merseycare  

This  presentation  will  describe  how  we  effectively  began  to  involve  people  with  dementia  and  carers  in  our  service,  from  a  position  where  there  was  no  involvement.  It  will  describe  the  process  that  we  used,  the  benefits  of  involvement  ,  our  learning  for  involving  people  in  a  meaningful  and  ethical  way  and  some  of  the  pitfalls.  We  will  include  a  person  living  with  dementia’s  perspective  

Presenters:  Jill  Pendleton,  Dementia  Lead  Liverpool  CBU/  Project  Manager  Innovate  Dementia  

 

Title:  Who’s  the  Daddy?  Kings  College  Hospital  

This  presentation  will  look  at  how  KCH  Dementia  and  Delirium  Team  (DAD)    addressed  the  challenge  to  ensure  all  older  adults  admitted  to  KCH  with  dementia  or  delirium  were  :-­‐  

• Identified  • Have  an  accurate  diagnosis  • Receive  person  centred  quality  care  by  skilled  and  knowledgeable  staff  • The  dementia  CQUIN  (Commissioning  for  Quality  and  Innovation)  gave  us  the  impetus  for  delivering  

this.  

Presenters:  Mona  Siyanga,  Dementia  CNS  (Education  and  Training),  Kings  College  Hospital  

 

 

 

 

 

THE  ISLINGTON  MEMORY  SERVICE.  

The  Islington  Memory  Service  comprises  a  Multidisciplinary  Team  which  provides  specialist  assessment,  diagnosis,  treatment  and  management  of  those  people  who  have  concerns  about  their  memory.  It  is  a  successful  service  that  has  contributed  to  the  borough  having  the  highest  rate  of  Dementia  diagnosis  in  London.  

Islington  CCG  has  a  vision  that  the  borough  will  be  the  “best  place”  to  have  dementia.  With  their  support  the  service  has  secured  additional  resources  to  meet  clinical  demand  and  deliver  an  improved  and  innovative  service.    

These  include  new  interventions  such  as    ‘Advanced  Care  Planning’,  allowing  people  with  Dementia  to  make  plans  for  the  future  when  they  no  longer  have  the  capacity  to  do  so  and    ‘START’,  an  evidence  based  manual  providing  coping  strategy  therapy  for  carers.  

Future  plans  include  introducing  the  Dementia  Navigator  Service  as  well  as  input  for  those  diagnosed  with  Mild  Cognitive  Impairment.  

 

Presenters:    Emily  van  de  Pol  –  Service  Manager    emily.vandepol@candi.nhs.uk  

Helen  Souris  –  Clinical  Team  Manager    helen.souris@candi.nhs.uk  

 

Title:  The  12000  Trained  Project,  Improving  Dementia  care  through  Education,  UCLPartners  

In  response  to  Health  Education  England’s  Mandate  to  train  100,  000  healthcare  professionals  in  Dementia  Awareness,  Health  Education  North,  Central  and  East  London  commissioned  UCLPartners  to  work  with  local  NHS  providers  to  deliver  training  to  staff  by  March  2014.    This  presentation  will  review  the  approach  and  highlights  of  this  project  and  update  on  the  progress  and  changes  in  culture  adopted  as  a  result.  

 

Presenter:  UCLPartners  12000  Trained  Project  Team  

 

Title:  NAPP  Pharmaceuticals  

NAPP  have  been  bringing  innovative  medicines  to  UK  patients  for  over  80years.  They  have  a  strong  track  record  in  bringing  benefit  to  patients  by  providing  treatments  that  incorporate  novel  delivery  mechanisms.  

This  presentation  will  look  at  how  pain  in  dementia  patients  is  under  diagnosed  and  how  this  may  impact  on  the  patients’  behaviour  and  consequent  inappropriate  prescribing  of  anti-­‐psychotic  medication.  The  presentation  will  look  at  some  methods  which  can  be  used  to  identify  if  a  dementia  patient  is  suffering  from  pain  and  how  analgesics  can  be  used  to  address  this  pain  and  improve  patient  behaviours.'  

Presenter:  Mike  Sangster  

We  are  most  grateful  to  NAPP  Pharmaceuticals  for  their  sponsorship  towards  this  event.