Professional Documents
Culture Documents
2008
66% of these patients are located within the
Medical Directorate.
45% of all cognitively impaired patients in
RCHT Eldercare setting
30% individuals - ‘bed-blocking’ whilst they
awaited discharge from hospital to care home
environments.
The RCHT Memory Service
provides
Diagnosis (with a front door service)
Rapid access to investigations and
assessments
Designated ward with specialty trained staff
Guidelines and Care Pathways
Supervision & reduction in
prescribing(sedation &antipsychotics)
Patient and Carer support
Improved Awareness and Education
Guidelines and Pathways
Guidelines Pathways and other
Behavioural Chart and
Dementia
assessment tools
Acute Confusion
Cognitive assessment tools
Dr Fiona Boyd
Bev Chapman
Kylie Cook
Maggie Trevethan
Aims
Retrospective Audit
Admissions involving NH
Identify the appropriateness of the
admission with a view to developing
pathways to reduce admissions and
facilitate more effective patient journey
Reference details: Audit number
Ward allocation(s): 1
2
3
4
Diagnosis (es) 1
2
3
4
Delaying factors
Place of discharge
12%
27%
‘Other’
General breathlessness
– fatigue/exhaustion/SOB (12%)
Admission from CPT
Step up care (4%)
Other important Findings
Palliative 29 (32%)
Treatment feasible in the Home 64
(70%)
What’s Next?
Analyse all data and correlate results
Clear patterns:
Yes
Use sedation if necessary. Adjust dose according to body mass and renal function. Review daily.
Only if severe distress or there is an immediate risk of harm to the person with dementia or to others.
24 hour behavioural
chart
Time 24hrs
Agitation/
Restlessness
Violence/
Aggression
Care Refusal
Wandering
Fall
Pain
Sleep Disturbance
Settled
Guidelines : Pain
> 50% of elderly suffer from painful
conditions
Pain control is frequently inadequate.
Demographic shift –increase in elderly
population
The number of patients with
dementia who will experience pain is
likely to increase.
Patients with Dementia
Negative None Occasional moan or groan. Low- Repeated troubled calling out.
vocalization level speech with a negative or Loud moaning or groaning.
disapproving quality. Crying.
Total**
Guidelines: Palliative
Understand the drivers to improving end of
life care for those with dementia
Identifying terminal phase care
Practical measures (care pathways)
Key Aims:
Determining whether someone is ‘end
stage’ – using clinical diagnostic indicators
and specialist support.
Identifying the patients needs (physical,
psychological, behavioural)
Identifying and managing symptoms
Support to carers and families.
Best Practices
covering:
Pain Assessment (reference to Pain Pathway)
Airway toileting and respiratory symptoms
Physical hygiene
Nausea
Mouth care
Tissue viability
Bowel care
Pastoral & Spiritual support.
What on For 2010
Re-launch –Let’s Respect campaign in
collaboration with ‘Worried About you
Memory’
What’s Your Story- Life Story Books
Education -Modular programme (In
collaboration with Learning Development)
Completion of RCHT Dementia Strategy and
Business Plan
Our Vision
Countywide Education Program (NVQ
Training and diploma status – County
Wide resource)
Countywide Network Forum
Link Nurses for Dementia –RCHT
End of Life –advanced planning
In Summary
There is excellent leadership and ownership
in advocating for dementia care in RCHT
allowing multidisciplinary assessments and
shared care with the psychiatric liaison
services.
Continuous drive to improve quality of care
The Royal Cornwall
Hospital