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P9. Hospital care II

Detailed programme and abstracts

P9. Hospital care II (Tuesday 1 Nov., 16.00 - 17.30)

P9.1. An innovative approach to culture change in hospital acute and critical care wards:  the best practice in dementia care learning programme

CAMERON Pauline

For over 25 years The Dementia Services Development Centre (DSDC) has worked to support multidisciplinary practitioners, professionals and organisations to improve practice through practical research based approaches that make a positive difference to people with dementia.

We know that people with dementia experience stress and distress when they are admitted for emergency care and that ill being continues and may increase following transfer to another ward or hospital department. One of the reasons for this is that the staff who care for them have poor understanding of dementia and its effect on a person. We recognise that staff are aware of their lack of knowledge and skills and that they experience stress because of it.

The Best Practice in Dementia Care Learning Programme is delivered in the workplace so learning has immediate impact on values, attitudes and beliefs about dementia and, consequently, on care delivery.  The content is patient-centred throughout, focusing on the needs of the person receiving care, and taking into account the experiences and observations of family carers. Participants are supported by a facilitator, who is also a colleague, to reflect on their own experience and consider how they might change their practice.

Since 2008, more than 8,000 staff have successfully completed the learning programme across the UK and internationally. It is accredited by the Royal College of Nursing and City and Guilds.

Evaluation has shown that learning has been received very positively by all participants. Staff report increased understanding of dementia and its effect on people and increased confidence when supporting patients admitted to hospital. Managers have seen the effects through whole departments noticing improvement in awareness of patient’s needs, team working, communication, morale and confidence.

P9.2. Overlooked possibilities for the use of person-center care during hospital admission of patients with Alzheimer’s disease

JENSEN Anders Møller, PEDERSEN Birthe, OLSEN Rolf, HOUNSGAARD Lise

Introduction: Hospitalization of patients with dementia in acute wards involves a multitude of problems for both the patient and the staff. The outcome of staying at hospital has also showed to be lower for patients with dementia. Ward layout, staff knowledge and work routines has been identified as areas worth improving, and both practical initiatives and research in these areas has shown it possible to improve hospital stay for patients with dementia. The existing literature however still lags knowledge about the possibilities of person-center dementia care during hospital stay.

Method: Patients admitted to hospital wards how also had Alzheimers disease (F001), was observed during day- and evening shifts from admission to discharge. The participant observation focused on staff and patient interaction, and the use of person-centered dementia care and psychosocial methods. Material from the observations was interpreted in a phenomenological-hermeneutic perspective inspired by Ricoeur's interpretation theory.

Results: The longitudinal data showed that even though staff had little specific knowledge about dementia care they were able to - through contact with the relatives, nursing home and observant praxis - gather information relevant for performing a qualified person-centered dementia care. However, much of the valuable knowledge was lost between shifts or simply drowned in overwhelming amount of information in the electronic patient journal, so much of the learning about the patient needs and wishes starter over again with every shift.

Conclusion: A better hospital stay for patients with dementia is multifractal, but making staff aware of the importance of the knowledge that they gather during their shift and of a more effective dissemination of the valuable knowledge, will greatly improve the foundation for a better hospital stay for patients with dementia.

P9.3. Promoting excellence in hospital care for people with dementia: a UK case study 

HEWARD Michelle, KELLY Fiona

In January 2016 the Alzheimer’s Society released a report stating that poor dementia care in hospitals across the UK is widespread, thatthe quality of care varies widely between hospitals and that millions of pounds are being wasted on substandard care. It is estimated that people with dementia over the age of 65 use up to one quarter of UK hospital beds at any one time, and are staying in hospital for longer than others go in for the same procedure; putting a resource strain on an already struggling health system. Audits of dementia care in hospitals in the UK have identified instances of poor care and inconsistent assessment, information sharing, planning and delivery of personalised care in hospitals.

In a move to improve outcomes for people with dementia in hospital in the South of England, the Wessex Academic Health Sciences Network has been working with eight acute hospitals on an Acute Care Development Programme; introducing interventions including visiting musicians, volunteer befrienders, open visiting, staff awareness of dementia and identifying dementia champions.

We are undertaking an evaluation of this programme using ethnographic methods including structured and unstructured observations, interviews, focus groups and participant diaries, to seek feedback from patients, family carers and staff of the interventions that each of the eight hospitals is undertaking. Each data set is being analysed separately, taking a realist approach, before undertaking a comparative analysis and triangulation of the data.

This paper presents findings including what worked (or not), for whom and why. It also discusses some of the challenges and learning when implementing psycho-social interventions within acute care environments and present ideas for other acute settings working to make improvements in patient experience and outcomes.

P9.4. Changing rooms: the redesign of emergency department bed bays for people with dementia

GIBB Matthew, ROCHE Denis, COLE Natalie, McMAHON Geraldine

St James's Hospital, Dublin undertook a three year project to improve the experiences of people with dementia within the hospital setting and in its’ links with the local community. Part of this project involved making changes to the environment to make it more ‘dementia-friendly’. This has covered a number of different areas including improved wayfinding, a report on a long-term care facility and the redesign of bed bays within the Emergency Department (ED).

In relation to the ED, the established principles of dementia design first formulated by Professor Mary Marshall fit well with residential type settings but only certain elements would cross over into the most acute areas of hospital care. The same could be said for the ‘dementia-friendly’ hospital design principles postulated by the Kings Fund in their Enhanced Healing Environments which would fit well with more generalized hospital settings, such as wards, but sit less comfortably in areas such as the ED.

The challenge, therefore, has been to utilise an adapted set of design principles that meet both the needs of people with dementia as patients in an ED setting and the needs of the staff who are tasked to care medically for them.

This paper will give before and after examples of the changes made to two bed bays in the Emergency Department, it will examine the effectiveness of the alterations and make recommendations for future work in similar environments.

P9.5. Delivering person-centred dementia care in hospitals

SMITH Kathryn, VAVASOUR Jo

Dementia is a challenge to the NHS accounting for 42% of older people with unplanned acute medical admission (Sampson, et al., 2013).

The Alzheimer’s Society own research reveals that:

  • 97% of nurse survey respondents always or sometimes care for someone with dementia
  • People with dementia remain longer in hospital than others and are more likely to experience emotional distress. 
  • People with dementia often deteriorate as a result of their hospital stay adding to carers’ physical and emotional exhaustion.
  • Discharge to a care home becomes more likely.
  • The Society has explored different hospital based service models to respond to this. Evaluation has demonstrated these:
  • Provide essential information and support for carers
  • Plug a gap in support for people first diagnosed in hospital or where dementia progresses.
  • Help to improve quality of discharge and reduce time in hospital.

However it also emerged that some of these service models are costly and do not always provide seamless support for people.

As a result we are developing our work in this area to further identify the needs of people with dementia in relation to planned and urgent admissions, longer term stays and discharge..

Based on understanding from our previous work, it is anticipated that this will result in:

  • a community based navigation/case management service providing tailored information and support.
  • training for hospital staff including non-clinical staff.
  • support to develop dementia friendly hospital environments.
  • volunteer led support during hospital stays and into the home at point of discharge.

P9.6. Becoming a dementia friendly hospital: an Italian preliminary experience.

NEVIANI Francesca, PELLITTA Antonella, TRIOLO Federico, LIBBRA Maria Vittoria, SAOTTINI Michele, VELTRI Francesca, RONTAUROLI Caterina, MOIOLI Olivia, FABBO Andrea, SGARBI Cinzia, MUSSI Chiara, BERTOLOTTI Marco

According to recent studies a large number of patients with dementia are hospitalized 1.5-2 times per year and their length of stay is longer than people without dementia.

Older adults, as well as their families and caregivers, are thus particularly vulnerable to systems of care that either do not recognize or are unable to meet their special needs.

As many countries have already done, we are trying to improve and facilitate hospital care for people with dementia (PwD) and delirium and their caregivers, developing a comprehensive plan based on the main characteristics of the “Gentle Care Model” and inspired by the principles of “Dementia-friendly hospitals”.

The program is based on three key areas:

  • Improve the knowledge about dementia and dementia care among the workforce
  • Modify the environment in which the process of care takes place
  • Support caregivers to cope with changes related to dementia progression during the hospitalization and after discharge

Since January 2016 we have started an educational program for nurses and other direct–care staff working in the geriatric ward of the Nuovo Ospedale Civile Sant’ Agostino Estense di Modena. This program also includes the possibility of offering psycho-educational support to caregivers and access to multi sensorial stimulation approach (Snoezelen) for PwD with severe behavioural disorders or delirium.

The process of caring for people with dementia who need hospitalization in an acute care setting is provided by a multidisciplinary team composed by geriatrician, case manager nurse, psychologist and occupational therapist.

At discharge the geriatric community services takes part in the follow up of our patients.

We aim to compare this innovative approach with traditional psychogeriatric evaluation for hospitalized PwD, to assess the efficacy in terms of BPSD improvement, reduce of restraints, antipsychotic drugs and ease the caregiver burden.

 

 
 

Last Updated: Tuesday 10 January 2017

 

 
  • Acknowledgements

    The 26th AE Conference in Copenhagen received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimerforeningen gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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