THINK FRAILTY – the journey continues

June Wylie

Time Item Lead

13.30 Welcome June Wylie (Chair)

13.35 Overview of OPAC work stream and progress to date

Penny Bond

13.40 Patient/Family/Staff experience Rowan Wallace

13.55 Engagement with families. Patient, family & staff experience (from ASSET team and ACE nurses)

Trudi Marshall

14.10 Panel Discussion Trudie Marshall/Brian Mcgurn/ James MacWilliams/Dianne Coleman/Rowan Wallace/Lesley Herd

14.40 Close June Wylie (Chair)

Penny Bond

Think frailty - the journey continues.....

Improving care for older people in acute care

Frail older people

•Have physical, cognitive and functional impairments

• Are often admitted with falls/immobility/ confusion due to significant underlying medical problems

• High risk of healthcare associated infection, delirium and under-nutrition in hospital

Why Frailty?

Tools being tested: Locally adapted frailty triage tools and criteria

Aim: 95% of frail patients (within

test sites) have access to

comprehensive geriatric

assessment within 24 hours of

admission, by March 2014

Impact:

•Comprehensive Geriatric

Assessment carried out within 24

hours of admission

•Reduction in length of stay in

hospital

•Reduction in boarding/hospital

moves

•Improved patient experience

Blurring of

boundaries - roles

Reduce LOS; Prevent

unnecessary admission

helpful to learn from

each other to improve

care delivery

Cross-sector working

& integration

Engaging families &

carers

Zero tolerance

for boarding

Identification of frail

older people is critical

Key messages

share

comprehensive

geriatric assessment

team work from

acute settings to

community hospitals

Dedicated unit for frail

elderly people with early

appropriate

treatment/discharge Right patient, right bed,

right time frame

Focus on frailty

@opachis

www.improvingcareforolderpeople.scot.nhs.uk

Rowan Wallace

Patient & Staff experience

Frail Older Person’s Pathway

NHS Ayrshire and Arran

Pilot period • Aim; to focus on the pathway starting in A&E

and improve the patient experience for people over 65

• Pre pilot discussions with staff and patients/families

• What is important to the individual? What makes a difference? What needs to happen to demonstrate that the project is an improvement?

The challenges

• A&E environment

• Difficult to predict when might be the best time to speak to patients

• Key stages of the journey

• Unable to rely on questions that have a basis in comparisons

• Measuring qualitative outcomes

What we did

• Conversation rather than interviews

• Discussions with staff

• Emotion words

• Defining what is important to the individual

How we did it

Observation

And Conversations

Staff /Team conversations

/comments

Patient/carer/family stories

Patient

Emotional map - Staff

9 empty beds in 3E

Wards & CDU asked to be more

embedded in pathway

Feeling that it wasn’t as slick

today to begin with

Red dot process

Had time in wards to plan

discharges

Ward CNs to spend time in

ED

Feeling tired but keen to

get going

Admin co-ordinators role vital in

identifying issues with process

Best shift ever in 3E

Saw everyone that we needed to even though

went past cut off time

Much busier day but we managed

Overall busy day

Emotional Map - Patients

A&E

Ward

Alternative to

admission

Home

Real benefit that

my father didn’t

need to be

admitted

A&E was an

experience – didn’t

like how busy it was.

More than I expected

– gold star

experience!

(interview in CDU)

10 out of 10, first class

service. Nothing to say

other than positive things

Great that my

husband could stay

with me

Scared that I

wouldn’t get home

Anxious

Initially I was concerned that

my mother was going home

from A&E but didn’t realise

what could be done to help

her at home

Going to a

step down

bed, not

sure what

that means

Great that I

am back

home, no

complaints

I was told that I

was going to a

72 hour bed –

that’s a relief to

know that I won’t

be in here for

long

Reshaping Care

Feedback from Scottish Government public engagement events shows that people want to be able to live in their own homes for as long as possible

People want services to be personalised and delivered in a joined up way that offers continuity and meets their needs

(COSLA, NHS, Scottish Government 2011-2021)

Mr Mc • 72 years old, lives at home with

son, who works shifts. His other son lives locally but works away from home for much of the week. Neighbour pops in a few times during the day.

• Went to pick up newspaper from behind front door, as he does every day. ‘Not sure what happened but fell and thought I had broken my leg’

• Ambulance called • Brought to A&E – FOPpathway

Mr Mc contd. • Examined, X-ray, No fracture, Pain control

• Step down bed

• Visited to discuss experience

‘ I am pleased that I am here and not in Hospital. I know that I am not ready to go home and don’t want to be a burden on my son. I am in so much pain and don’t want to get up and try moving around. The Doctor explained that it would be better for me to be here and not in the hospital and that it was a shorter term thing, they expect me to be going back home....I’m delighted to hear that, I’m too young to be ‘looked after’ and still want to live in my own house’.

Mr Mc contd.

• Visit at Home ‘I am feeling much better and happy to be back at home. The

whole experience was good, I enjoyed being in the step down place, they treated me so well and the Physio helped me to get up and moving again. I didn’t think that I would be able to do it but she told me what to do and helped me, if I was left on my own, I wouldn’t have even tried! I was worried that my son would have to give up work or I would end up in a home and that would be me........ I have my dog for company and can see to him myself, I can’t walk him but can do everything else’

Lessons learned • People can be worried to give their opinions

whilst still in Hospital

• Family and Carers are often more outspoken

• Generally the care and treatment given is appreciated and there is a sympathy towards the staff in relation to workload

• Service and patient priorities can differ

• Timing of the discussions is important

Trudi Marshall

Trudi Marshall

Brian McGurn James

McWilliams

Rowan Wallace

Lesley Herd

Diane Coleman