Supporting older patients with confusion and dementia
UHCW is committed to ensuring older patients with confusion and dementia receive an effective and compassionate service from the hospitals. Older people with dementia are admitted to the hospital for the same reasons as patients without dementia, but their stay may be more problematic due to not coping well with change of routines, noisy busy environments may be very confusing to them. They may feel frightened and bewildered, have difficulty expressing their needs, and their physical and mental health may also deteriorate further leading to increased length of stay.
Dementia is a term used to describe a group of symptoms that occur when the brain is affected by specific conditions. Dementia is a complex condition as in the early stages a person may appear to be coping well, but may be experiencing difficulty with communication or memory which other people may not realize, this is particularly so if the person is out of their normal routine or in a strange place. Symptoms of dementia include memory difficulty, disorientation and speech and understanding.
The National Dementia strategy (DOH 2009) highlights many of the problems that patients with dementia face in acute hospitals and gives a strategy on how to improve on this.
Staff at UHCW are committed to fulfilling the objectives outlined in the plan. The Trust has a lead senior doctor and two Clinical nurse specialists to support the recommendations of the strategy.
Over the last ten years the Trust has promoted a number of strategies to ensure that patients feel safe, their relatives are involved in the person’s stay and they do not develop complications because of their confusion which results in them having to stay in hospital for longer periods of time. Many of these strategies are outlined in the 2009 National Dementia strategy.
The Trust has launched a campaign to highlight the importance of providing special skills to all staff who work with patients with confusion and dementia. The CORE values were developed by the Stirling University.
The CORE Approach emphasises the importance of Communication, Orientation, Repeated reassurance and Environment. A poster and leaflet have been developed and short teaching sessions are planned to enable all staff groups including hostess and porting staff to use the CORE values in all their interactions with people with dementia. For instance a porter taking a patient to the X-ray department may need to use the these skills to explain and reassure the person to prevent agitation and distress likewise a doctor can use these skills to determine if the person is in pain.
Other Interventions are in place to support patients with dementia in hospital these include:
- The Trust employs two clinical nurse specialists who have developed an understanding dementia course to all grades of staff since 2002; training has been increased to include induction of new staff and shorter awareness sessions
- Early identification of patient needs by encouraging medical and nursing staff to gather background history.
- Early identification and treatment of delirium promoting the use of the CAM (a tool for assessing a person with delirium) in all clinical settings
- The Trust works in partnership with the Hospital Liaison Team and has access to old age psychiatry, as UHCW is often the first port of call for patients with an undiagnosed dementia
- The Trust has employed a specialist nurse who works primarily with the residential sector to prevent unnecessary admission to hospital. This is particularly useful for patients in the terminal phase of illness
- Involving the carer as soon as possible on admission, encouraging relatives to use the “getting to know me form”. Important personal information about how the person normally manages in their own environment, such as what does the person like to be known as; what helps them to feel calm; what helps them to eat and drink; how does the person express pain and discomfort? The use of a pain assessment tool, such as the Abbey Pain Assessment Tool may also help staff recognise pain for patients who cannot express pain verbally
There is a large drive within the Trust to ensure all patients especially those who cannot speak up for themselves to have enough to eat and drink. This is particularly true for patients with dementia.
Great attention is given to ensure patients are assessed on admission, that carers are contacted to find out how the person normally manages. Allowing carers to visit out of hours to help the patient with eating and drinking. Ensuring staff in clinical give areas give priority to spending enough time to ensure older frail patients have their food positioned correctly and they have the equipment needed.
The training that the clinical nurse specialist provide, encourages staff to understand challenging behaviour as an expression of a need and to try to work out triggers as this behaviour often has multiple causes (e.g. physical mental, environmental, neurological) which is moderated by people’s emotions and beliefs, that is why we promote staff to use of the ABC CHART.
The employment of Activity organizers to prevent boredom and cognitive decline and the involvement of volunteers to “befriend” patients during the day, the volunteers also purchase the materials that go in to the activity packs.
The two Clinical nurse specialists Rose O’Malley and Liz Kiernan, between them work 9-5 Monday- Friday. They can be contacted by dialing 024 7696 4000 and asking for either Rose on bleep 2603 or Liz on bleep 4188. They are both happy to answer questions on any of the interventions already mentioned and give advice and support to clinical staff on any aspect of care relating to older people with dementia which includes:
- Mobility Discharge planning
- Dealing with difficult behaviour
- Mental capacity advice
- The use of deprivation of liberty safeguards