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Activities in Hospitals

Activities in Hospitals. Dr Lesley Young Consultant Geriatrician Sunderland Royal Hospital. Sunderland Royal Hospital. Large DGH in the north of England 855 beds including ~150 acute Care of the Elderly >30,000 admissions/yr Sub regional centre Historically a ship building and mining town

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Activities in Hospitals

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  1. Activities in Hospitals Dr Lesley Young Consultant Geriatrician Sunderland Royal Hospital

  2. Sunderland Royal Hospital • Large DGH in the north of England • 855 beds including ~150 acute Care of the Elderly • >30,000 admissions/yr • Sub regional centre • Historically a ship building and mining town • Population is mainly white British, high levels of social deprivation and co-morbidity • Highly computerised system

  3. Our journey in improving dementia care in hospital • Prior to 2010 • V limited liaison old age psychiatry (1 nurse) • Low priority for Trust • Poor performance in 2010 NAD • April 2012: • UK government introduce National Dementia CQUIN • Oct 2012: • Business case for dementia approved by Exec board, IF we guaranteed to meet CQUIN

  4. Summer 2013-2015 • 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 dementia CQUIN • Proactive identification of patients with cognitive frailty at the front door • Provide a hospital wide delirium service • Meet policy expectations

  5. Evidence and policy base • NICE Dementia guideline 43 • Promoting independence and maintaining function • Structured group cognitive stimulation • Interventions for non-cognitive symptoms and behaviour that challenges • Aromatherapy • Therapeutic use of music/dance • Animal assisted therapy • Massage • Exercise

  6. Evidence and policy base • NICE Delirium guideline 103 • 1.1 identify those at risk • >65, cognitive impairment, hip fracture, sever illness • 1.2 identify prevalent delirium • 1.3 Interventions to prevent delirium • 1.3.3.1 introducing cognitively stimulating activities • 1.3.3.2 address dehydration • 1.3.3.5 address immobility by encouraging active range of motion exercises • 1.5 diagnosis • 1.6Treating delirium • 1.6.2 ensuring effective communication and reorientation, providing a suitable care environment • 1.6.3 de-escalation

  7. 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)

  8. 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

  9. DDOT Activity

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

  11. Dementia friendly design, using Stirling university tool

  12. 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

  13. 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

  14. Dip in service provision seen in July with loss of member of staff. • Dip in service provision in September due to short staffing on wards

  15. Alexandra Centre • Information resource for staff and carers • Open access leaflet area • Drop in sessions for voluntary agencies

  16. Staff feedback • 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)

  17. Staff feedback • Subjective view of ward staff on impact of DDOT and Alexandra centre • Actual in patient falls reduced by 28% April/May 2015 compared to April/May 2014

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

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

  20. Thank you Any Questions? Lesley.young@chsft.nhs.uk

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