changing practice in nursing and care homes
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Changing Practice in Nursing and Care Homes. National Dementia Learning Event 29 th September 2011 Jillian Torrens, Adult Services Manager, Glasgow CHP - South Sector Jean Hannah FRCGP, Clinical Director, Nursing Homes Medical Practice. Sharing ideas: service delivery models. - PowerPoint PPT PresentationTRANSCRIPT
Changing Practice in Nursing and Care Homes
National Dementia Learning Event29th September 2011
Jillian Torrens, Adult Services Manager, Glasgow CHP - South SectorJean Hannah FRCGP, Clinical Director, Nursing Homes Medical Practice
Sharing ideas: service delivery models
Variety of NHS models support people living in care homes:
• Standard GP registration• Local Enhanced Schemes• Dedicated services• Retained GPs
Successful joint working
• Care Home Services - Care Home Liaison Nurses, Dietician, SLT, Clinical Pharmacy Team, Admin. Team, PM, NHMP GPs, CD & Adult Services Manager
• 70(58) nursing homes & ~ 3500(2650) residents
• Central Practice – 1050 patients – 67% dementia– 10% ≤ 65 years – 36% dementia
Assessing the Prevalence of Dementia. Audit and Cognitive Screening in Glasgow Nursing Homes
Stephen Lithgow. Dementia Clinical Studies Officer. Specialist Occupational Therapist. NHSGGC Sept. 2010.
Objectives: 1. Audit care plans and establish existing levels of dementia
diagnosis in nursing homes. 2. Use cognitive assessment to establish levels of possible
undiagnosed dementia. 3. Update care plans and GP records with cognitive test results4. Inform GP’s of residents who may have undiagnosed dementia.
Methods & results
• Random selection 1 in 6 residents• 48(49) NH & 403/422 nursing home residents
Glasgow City• Standardised Mini Mental State Exam (SMMSE)• If difficulty participating, Functional Assessment
Staging Tool (FAST) used• 89.9% had scores in dementia ranges
124.8
47.2
76.6
186.6
104.1
116.9
636.5
151.3
64.8
355.6
99.2
8.8
79.6
187.6
13.1
56.8
13.6
43
29.2
22.8
5.7
39.4
7.9
125.9
29
4.6
9.3
20.2
AF
Asthma
Cancer
CHD
CKD
COPD
Dementia
Diabetes
Epilepsy
Hypertension
Hypothyroid
LD
Mental Health
Stroke
NHMPGGC
QoF Disease Prevalence /1000 Patients (Central Team n = 1018)
Provision of palliative care forpeople with dementia & their carers• New patient registration – hospital liaison• Supportive & Palliative Action Register (SPAR)• Early identification of those who may need palliative care• Advance/anticipatory care planning, including anticipatory
prescribing• Liverpool Care Pathway for the Dying• Accessibility to patient, carers and staff vital – encourage open
communication• Finding out about how we can do better
Preferred place of care
• Majority of nursing home patients and their carers hope that death will occur in nursing home
• Standard GP: 7-8 deaths per annum frailty or dementia, and total approx. 20 deaths per annum
Central Practice
Hospital % Nursing Home
% Total Deaths per GP
2008 57 20 227 80 284 372009 57 20 233 80 290 382010 62 20 246 80 308 40
Out of Hours Contacts
Annual Total (Oct-Sept) Calls/Patient/Yr• 2008-09 872 0.3• 2009-10 1118 0.4• 2010-11 1105 0.4
Contacts for deaths: 15% 2009 to 7% 2011
Hospital contactsNorth Glasgow Year A&E
2008-09 460
2009-10 332
20010-11 320
Total 1112 – 65% admitted
South Glasgow Month Admissions
June 2011 8
July 2011 8
SPARRA July 2011
936 patients post code for NHMP 385 dementia (41%) of which 70 Alzheimer’s
The future care and support of peoplewith dementia living in care homes
• Early diagnosis and support – how and who by?• Standardisation of GP support i.e. clear
specification with supporting IMT screens and reporting requirements
• Continue to strengthen evidence base for what works well and what does not
• Use this to support appropriately resourced services to individuals, families and carers
Workshop discussion point 1
Dementia diagnosis: views vary from “Anyone can diagnose dementia” to “Everyone with possible dementia should have a diagnosis made by a specialist (memory clinic or old age psychiatrist)”
For discussion: barriers & supports to diagnosing dementia and the impact of getting it wrong.
Workshop discussion point 2
Early dementia diagnosis:Many patients in care homes have undiagnosed
dementia and are cared for in a variety of care home settings.
What would the desired outcomes and benefits of early diagnosis be?
What changes to support, care and service provision would be needed to realise these?