the role of the dementia care home liaison nurse within south east essex jackie smith clinical nurse...
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The Role Of The Dementia Care Home Liaison Nurse Within
South East Essex
Jackie SmithClinical Nurse SpecialistDementia Care Home Liaison Nurse
Background
• Pilot study with 4 dementia care homes in 2009• Baseline figures: 136 residents, 84 on anti-psychotic’s• Only 26 had received review of medication• No on-going monitoring• Referral into secondary care high and could take up-to
12 weeks before review/outcome• High usage of other health services• Homes felt un-supported• Lacked information for alternatives other than
medication.
Current Practice
• Pilot now permanent and has extended to West/South Essex.
• Currently 3 Dementia Liaison Nurses covering approximately 200 care homes
• 2 band 7’s and 1 band 8 nurses• Roles have extended since original pilot• Feedback indicates improvement in service• A substantial reduction in GP calls• A significant reduction in hospital admissions• Less medication prescribed for behavioural
problems
Aims of Liaison Nurse• To support Care Homes• Hospital Avoidance• To promote alternatives to antipsychotic use• To promote closer integrated working• To promote access to Health & Social Care• To identify undiagnosed conditions• To promote enhanced care• End of Life care in dementia• Ensure regular reviews including medication
(Psycho-tropic medication reviews)
Work of the Liaison Nurse
• Direct Referrals from Care Homes • Referrals accepted from: GP’s, Primary Care,
Psychiatrist’s, Wards, Social Services, Acute Trusts, • Fire fighting: behavioural disturbance, • Concerns about physical or mental health, • Concerns from relatives• Mental Health Assessments• Medication Reviews• Monitoring of anti-psychotic’s• Integrated Working• Training
Working Practice• Liaison work in East
extended to 20 homes• Every resident undergoes a
review• Each home visited regularly• Each home able to contact
me directly• All newly admitted residents
are seen and reviewed• Relatives given information• All prescribed antipsychotic
medication monitored • Usage of other professionals
• Each home offered supplementary training
• Advice given on managing “challenging behaviour”
• Links into local GP’s
• Links into community pharmacists
• Assistance given to homes in Care Planning
• Open surgeries for staff/relatives
• Encouraging homes to use evidence-based tools to support care
Working Practice
• Training a big issue
Need to Ensure the Following:
Changing attitudesMoving away from ritualistic practice
Homes taking more ownershipIntroduction of closer working linksSharing of information with homesDevelopment of more “Person Centred” care
Changes that have occurred
Staff protected time
Access to community geriatrician/stroke services
On-going support
More confidence
Confidence in managing more “challenging behaviour”
Ensuring Capacity Assessments completed
Increase on EOL register
Overall reduction of admissions
Anti-Psychotic Prescribing
• Any person with dementia prescribed an anti-psychotic undergoes review.
• Where continuation is required monitoring forms completed
• Minimum review of 6 weekly – maximum of 3 monthly
• Risperidone drug of choice. • Risks discussed with
relatives/carers.• Side-effects highlighted• Staff given information• Behaviour charts used
• Over 500 people being monitored
• Only 37 on anti-psychotic• Noted undiagnosed
depression• Feedback from GP’s very
positive• Increase of alertness• Reduction of falls• Better diet/intake reported• Increase usage of
Memantine• 0 referrals into CMHT
On Going Work
How we can support primary Care
Reducing unnecessary GP call outs
Facilitating referrals
Identifying cases for Dementia Register
Meeting QOF targets for reviews
Reducing use of antipsychotics
Improving access to mental health advice, consultation and support
Future work?
•Feedback Excellent•Care Homes / Primary Care •Qualitative data reported to support impact•Awaiting Metrics•Possible developments•More Liaison Nurses•Dedicated Pharmacist hours•Monitoring cognitive enhancers
Area’s For Further Development
Give the homes the necessary support Identify a standardised training programme Develop a support network for care homes More collaborative working across all professionals
(Primary/Secondary/Acute) Expansion of Dementia Care Home Liaison Nurse roles Care Homes to develop non-pharmacological approaches Addressing the environment Sharing of information Implementation of local register of anti-psychotic’s prescribed
for people with dementia Education and training for primary and acute trust staff
Questions?
Thank-you for your time and attention
Jackie Smith
Clinical Nurse Specialist
Dementia Care Home Liaison Nurse
E-mail: