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Maureen Strudwick & Tony Phiskie Carer Support Units CCLHN & SWSLHN March 2011

TOP 5 – Engaging CALD carers to personalise hospital care for people with cognitive impairment. Maureen Strudwick & Tony Phiskie Carer Support Units CCLHN & SWSLHN March 2011. TOP 5. What is TOP 5 Pilot Study Implementation Evaluation. TOP. 5. What is TOP 5?. A process to

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Maureen Strudwick & Tony Phiskie Carer Support Units CCLHN & SWSLHN March 2011

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  1. TOP 5 – Engaging CALD carers to personalise hospital care for people with cognitive impairment Maureen Strudwick & Tony Phiskie Carer Support UnitsCCLHN & SWSLHN March 2011

  2. TOP 5 What is TOP 5 Pilot Study Implementation Evaluation TOP 5

  3. What is TOP 5? • A process to • identify & engage the carer of a patient with cognitive impairment. • negotiate and record up to five carer “strategies” that promote person-centred care and communication on the ward. TOP 5

  4. Where is TOP 5 located? • Strategies are documented and located on the bed chart. • an I.D. tag is placed on the top of the chart • a sticker is placed on the spine of the medical record. TOP 5

  5. TOP 5 is person-centred practice which • Recognises the importance of engaging carers. • Values their knowledge, expertise and tips in caring for their care recipient. • Effectively communicates carer’s information across sectors, people, systems. • Creates a more settled and comfortable environment • Reduces incidents of adverse events

  6. TOP 5 Pilot • 4 Acute Care Wards were targetted for 8 week Top 5 pilot • Top 5 Champions were sought and trained • Staff and Carers were surveyed pre and post pilot • Staff were trained in carer role, and carer engagement TOP 5

  7. Top 5 Pilot Study Results Staff reported patients to have: • a quicker recovery • less agitation, frustration and distress • more effective communication • increased ability to relate TOP 5

  8. Top 5 Pilot Study Results Carers noted staff to: • have increased awareness of their role (58% to 90%) • invite them to share patient information (54% - 89%) • listen and take on what they shared (54% - 72%) TOP 5

  9. TOP 5 Implementation • Gain support • Address Issues • Communicate Gains TOP 5

  10. Gain support • Establish partners: • Ward leaders - NUMs, CNCs, CNEs, • Delirium & Dementia CNC • Ward ‘champion’ for “Carers as Partners in Care” TOP 5

  11. Address Issues • Resistance to “yet another thing to do” • Create confidence in the process using “champions” to model the process and to coach their peers, • Demonstrate value of TOP 5 by using feedback at ‘handover’ and case conferences • Embed TOP 5 in protocols for ward admissions, falls prevention, and delirium detection. TOP 5

  12. Communicate Gains • Wins for all parties • Reduced incidence of adverse events • Reduced length of hospital stay • Improved safety for patients, and staff • Improved staff/patient & staff/carer relationships TOP 5

  13. TOP 5 Evaluation 2010 • 9 hospital wards in the CCLHN were included in the survey • 64 Staff members included 43 nurses, 9 ward nursing executive, 2 medical and 10 allied health staff were interviewed TOP 5

  14. TOP 5 Evaluation Results • 93% of staff were aware of Top 5 • 91% of staff reported Top 5 strategies benefit the patient • 98% of nurses reported Top 5 strategies benefit them in nursing the patient • 98% of staff said they would recommend Top 5 to colleagues and other health professionals TOP 5

  15. TOP 5 Evaluation Staff Comments: • “Highly recommend it” • “A great initiative” • “Makes my job easier” • “Less pressure, helps with knowing a patient” • “Easy to use” • “Very effective” • “Really good resource tool, promotes patient comfort” TOP 5

  16. TOP 5 for CALD Carers Getting Started in SSWAHS Lessons Learnt TOP 5

  17. Interest in TOP 5 in SSWAHS • Carer from SSWAHS Community Participation Network had heard Maureen’s presentation at 09 Conference • Raised as agenda item at CAP committee Sep 09 • Resolved to investigated interest in Top 5 • Carers’ Program sent names of “interested parties” • Meeting of “interested parties” called for Oct 09

  18. Carers’ Program, SSWAHS investigate TOP 5 • EOIs asked from potential Top 5 sites • More info sought from CSU, NSCCAHS • I attended Dementia Café • Maureen invited to present • TOP 5 promoted on Intranet Bulletin Board (Home Page) • Overwhelming response – 85 rsvps

  19. NUM Quote on interest in TOP 5 “What appeals to me is the simplicity of the initiative and the simplicity of the actual Top 5 page that will go in the patients bed chart . . . . and the absence of the 25 page instruction manual; mandatory one day education; policy requirements; mandatory education about the policy; the mandatory monthly data reporting; and mandatory training on the mandatory monthly reporting data.”

  20. Concerns by Carers Program • No dedicated staff member to oversee project • Is current context appropriate to embed TOP 5 • Budget • Staff shortages • Introduction of LHNs

  21. Incorporating CALD Population • Liverpool Aged Care Unit have developed resources for CALD patients and Carers. • CNE of Liverpool ACU attended first planning meeting & Maureen’s seminar and raised issue of Carers Program of CALD carers • Close to 50% of patients in Aged Care Unit from CALD backgrounds

  22. CALD Population in SSWAHS • the most culturally diverse populations in NSW live within the Sydney & SWS LHNs • 40% speak LOE at home (26% in NSW) • 60% in Fairfield and Canterbury • Greatest no. speaking LOE at home: • Arabic, Vietnamese, Cantonese, Italian & Greek

  23. CALD Population in Liverpool • SSWAHS Translation and Language Service • Identified 5 major community languages in Liverpool LGA: Arabic, Chinese, Serbian, Spanish, Vietnamese Translated TOP 5 resources into Community Languages • The brochure on Top 5 • The pre and post Top 5 evaluation surveys

  24. Establishing commitment • Meeting of interested staff (April 2010) – good response 20 staff representing Balmain, Bankstown, Bowral, Camden, Campbelltown, Liverpool. • Braeside (Fairfield Aged Care), Fairfield Hospital and Concord hospital also expressed interest. • Outlined what the Carers Program could offer in way of support and funding for CALD resources • Developed a process for getting things started.

  25. The process begins …. • Staff went back to their workplaces to garner local support for TOP 5 • Essential that Working Groups established at each site • Balmain, Bowral, Braeside, Camden, Liverpool, Fairfield • ISSUE: Lot of interest BUT Carer Program unable to provide backing at the rate of rollout.

  26. Working Groups established…. • Carers Program letter to facility administrations • TOP 5 processes established: • Training of Staff • Development of Manual • Starting date • Staff trained at each site • Balmain – all wards • Camden – Medical Transit Unit • Liverpool – aged care wards

  27. CALD Patients and Carers • Clinicians identifying CALD patients and carers receiving ‘less than’ service • Use of interpreters • Communication issues • Requires greater staff effort for same result with patient • Cultural differences around the role of family and carer • Religious beliefs, superstitions • Variations in translation of English

  28. Research Confirms Clinicians Experience • Local and National research has established access barriers for CALD Carers: • Difficulties with language • Lack of knowledge of services • Lack of culturally & linguistically appropriate services & assessment for their carees

  29. Local Focus Group Research Aged Care Research Unit, Liverpool Hospital • Not speaking English was a major issue in communication of information • Need for Dementia education for CALD & broader community • Hospitalisation noted as a factor in the decline in condition of PWD • Comments on Dementia care in Dr’s surgeries, Day Care Centres, Residential Care facilities and Community Services. • Lack of understanding & culturally appropriate care in hospitals

  30. Instigating TOP 5 with CALD Carers • WHO? • Nursing are 24 hours, 7 days a week • Nurses have specific high priority protocols that MUST be followed prior to end of each shift • Nursing has competing demands on time, energy, and mental space BUT TOP 5 WILL START OR FINISH ON THE WARD

  31. Instigating TOP 5 with CALD Carers con’t • TIME • Arranging time with carer • Booking interpreters • Time-poor Nursing staff looking at longer time to work with CALD carers • Cultural differences impact on relationship between carers and staff

  32. Feedback Essential • Staff need to know that Top 5 is worth the effort • Limited day-to-day involvement Carers’ Program • Local data collection – CALD Carer specific

  33. Lessons Learnt • Need for a dedicated project worker to support working parties • Engage Geriatricians • Working Parties need to be endorsed formally by executive • Definite commitment by nursing administration • Working Parties staff training must include engaging and communicating with CALD carers • Involvement of “community”

  34. …and more lessons … Establishing Worth & Good Will • Hospitals • Networks – hospital and community networks • Working groups • LHN Executive • Community • General Aged Care • CALD groups

  35. REFERENCES • NSWHealth “Carer Action Plan 2007 – 2012” • Alzheimer’s Australia Victoria “Perceptions of Dementia in Ethnic Communities “ October 2008. • NSWHealth “Easy Guide to Clinical Practice Improvement” 2002 • Foreman, P & Gardner, I. (2005). Evaluation of Education and training of staff in dementia care and management in acute settings. Melbourne:Victorian Department of Human Services Web references: www.health.vic.gov.au/agedcare/ www.nsccahs.health.nsw.gov.au/carersupport/cc/centralcoast.shtml

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