Dementia champions: our experiences and challenges

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1 Dementia champions: our experiences and challenges Dr Louise Mellor Foundation year one doctor Dr. Iain Wilkinson, SPR Geriatric Medicine Mrs. Sasha Wade, Service Improvement Lead Dr. Chooi Lee, Consultant geriatrician

2 Dementia: Junior Doctors Championing Change Dr Laura Tucker, Dr Catherine Pye, Dr Louise Mellor

3 Dementia 800, 000 people live with dementia in the UK Specialised care Access to social services and support Early diagnosis

4 Poor detection Previous audit showed poor cognitive assessment on admission (21%) Patients with cognitive impairment missed Missed opportunity for: Specialist in-patient management Appropriate follow up and referral to community support services

5 What we did Junior doctor dementia champions volunteered Monthly National Dementia CQUIN audit: 1. Screening question 2. AMTS within 72 hours (brief cognitive assessment) 3. Appropriate investigations performed if indicated 4. Appropriate referral for specialist diagnosis Wards bench-marked against each other and informed of monthly progress

6 Aims Identify Improve rates of diagnosis Improve rates of referral Empower junior doctors to make sustained improvements in care for patients with dementia on the wards Find Assess Investigate Refer

7 % of Patients >75 years old admitted to Kingston hospital who were asked the memory screening question compared to Local CQUIN Target 100% 80% 60% 40% 20% 0% Sep-12 Oct-12 Nov-12 Dec-12 Hospital Average Local CQUIN target 100% 80% % of Patients >75 years old admitted to Kingston Hospital who had an AMTS recorded within 72 hours of admission compared to Local CQUIN Target % of Specialist referrals for patients with suspected dementia admitted to Kingston Hospital compared to Local CQUIN Target 100% 60% 40% 20% 80% 60% 0% Sep-12 Oct-12 Nov-12 Dec-12 40% 20% 0% Sep-12 Oct-12 Nov-12 Dec-12

8 Quality Improvement Forget-me-not dementia scheme 8 important things about me Carer s passport Carer information leaflets Hospital-wide education and training Top-tips for looking after people with dementia

9 Continuing the good work April 2013 audit results showed: 98% use of screening question 99% AMTS usage on admission 100% referral to specialist services on discharge. Continue monthly audit Establish the use of the forget-me-not scheme on the wards Education and recruitment of new champions with the new FY1 doctors start in July

10 Junior doctors leading change Conclusions Changing dementia awareness and culture Lasting changes in attitude and behaviour Improving quality of care and experience of patients and carers

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12 The Forget-Me-Not scheme is coming to your ward!

13 At Kingston hospital, we care about people with dementia Our goals are structured by our 5-point plan: Making SPACE for good dementia care

14 SPACE Staff who are skilled and have time to care Partnership-working with carers -Take the time to get useful information and involve the carers/loved ones Assessment and early identification of dementia Care plans - relationship-centred and individualised Environments - dementia friendly environments

15 Assessment and early identification of dementia

16 Care plans should be person-centred and individualised

17 Care medically should be meticulous and excellent

18 Partnership-working with carers

19 Partnership-working with carers

20 Care and Partnership-working with Carers Provide information and support

21 Prevalence of dementia in patients aged 75 and over in Kingston hospital In total, 48% of patients had dementia or suspected dementia 89 out of 184 patients 54 patients with known dementia 35 patients with suspected or new diagnosis of dementia

22 A person with dementia hospital may not know. Who they are Where they are Why they are there A person with dementia in hospital might feel: confused.frustrated.angry. upset.embarrassed...distressed alone frightened

23 People with dementia in hospital are more likely to: People with dementia in hospital are more likely to: Have major complications (falls, malnutrition, delirium, pressure sores, incontinence) Stay longer Be re-admitted after discharge Deteriorate mentally, physically and functionally Be discharged to institutionalised long term care

24 Forget-Me-not Top Tips for Dementia Take time, slow down. Faster is not more efficient when it comes to good dementia care. Know the Person. Fill in and review the patient s 8 Important Things About Me form. Involve the Family/Carers. They know the individual better than anyone. Use the Carer s Passport. Enhance Communication. Limit your words, use gestures, and offer choices. Ensure dentures, hearing aids and glasses are in place. Interpret Behaviours. Behaviours often reflect unmet needs. Pain? Needs the toilet? Too noisy? Afraid? Lonely? Bored? Go With the Flow. Be flexible, validate concerns, use alternate approaches, try again later, talk about happy times, and tailor your care to each individual. Watch for Signs of Delirium and Depression. Common co-morbidities with dementia. Ask for Help. Ask your dementia champions, colleagues, carers or volunteers.

25 Forget-Me-not Top Tips Take time, slow down. Know the Person. Involve the Family/Carers. Enhance Communication. Interpret Behaviours. Go With the Flow. Watch for Signs of Delirium and Depression. Ask for Help.

26 The Forget-Me-Not scheme is coming to your ward!

27 Activist Professionalism Dr. Iain Wilkinson Specialist Registrar General Medicine and Geriatric Medicine

28 Professionalism What makes / does not make a professional? Key components 1 : Specialised knowledge, Monopoly of service, Autonomy for practice, Code of ethics. 1. Freidson, E. Professionalism Reborn - Theory, Prophecy and Policy. Polity Press, 1994.

29 Professionalism and Dementia assessment In many hospitals this assessment is performed by the junior doctors Imposed and led in a top down manner May lead to a sense of deprofessionalisation by the junior medical doctors little control over the system they work in and may not encourage their active participation.

30 The Activist Professional Activist professional Shift of the focus from an individual's actions to those of the group as a whole 2 Harnesses trust, obligation and solidarity 2 Often work to provide care to a minority or underserved group 2 The dominant concern is social justice 3 These junior doctors felt that they had championed a change in the culture of the hospital to give lasting changes affecting the care of patients with dementia 2. Sachs, J. The Activist Professional. Journal of Educational Change 1, no. 1 (2000): Castellan B, Hafferty F. The Complexities of Medical Prefessionalism. In Professionalism in Medicine - Critical Perspectives, by Julie Aultman Delese Wear, 3. Springer, 2006.

31 Conclusions It was (is) easier than we thought Our message is easy to understand Staff are dedicated and passionate about looking after their patients well Be prepared with your elevator pitch Ward to Board Dementia champions: executives, non-executives and governors. Go to them than get them to visit

32 Conclusions Modelling good practice Inspiring shared vision Challenging the process Enabling others to act Encouraging the heart James Kouzes and Barry Posner The Leadership Challenge (4 th edition)

33 Thank you for listening