Improving

Recognition and

Care of Cognitive

Impairment on the

Mornington

Peninsula

Robyn Attoe

Cognition Clinical Nurse

Consultant (Acute)

Outline

• The Mornington Peninsula

• Our challenges as a service provider

• Education -Executive buy in to support and drive

change.

• Inter disciplinary approach to Education,Training

and Carer support

• Other Initiatives -Delirium Guidelines /TOP 5 /Pet

PALS/ Passport to Care

The Mornington Peninsula Our Community

The FMPML catchment current ly has approximately 4,510 people with dementia. Mornington Peninsula Shire has the

2nd highest prevalence of dementia in Victor ia and this is projected to cont inue for the next 40 years.

Current Challenges

Dementia, Ageing and Mild Cognitive Impairment are risk

factors for developing Delirium, therefore our services will

likely see an increase in Delirium in our admitted elderly

patients.

Triggers for Change

- Escalation in workplace aggression. Occupational

Violence, CEO chairing Committee

-Operations Director for Subacute supported and drove

education and training program for all staff at the

Mornington Centre.

- ACSQH Delirium Clinical Care Standards ( July 2016 )

Ensure a skilled and informed workforce: “Safe and

high- quality care is dependent on a workforce with the

right knowledge, skills and attitudes. The whole workforce

has a role in providing care and creating a patient- centred

culture. This requires continual targeted education,

information and training for all levels of staff.”

(Australian Commission on Safety and Quality in Health Care, Commonwealth of Australia 2014)

Delirium Clinical Care Standards

How have we as an organisation started to

address this?

Education and Training

Development, rollout and review of Delirium,

Guidelines est. 2013-reviewed 2016

CDAMS post diagnosis information sessions

Adopt a pet therapy pal

PDAG collaborative community forums.

Passport to Care

Summary of the training

Collaborative approach across the disciplines.

• The group committed to fortnightly, four hour face to face training sessions to be run

at the Mornington centre in the mornings. There was a prerequisite of an online

learning component prior to attending.

• The topics covered were:

Communication (speech therapy)

Diversional Therapy (what is it and how do we best utilise the service)

BPSD, best practice management (delivered by one of the medical team)

Occupational mindfulness and self awareness

From July 22nd to November 23 rd seven sessions were held at the Mornington Centre.

60%of the nursing and allied health staffing group undertook the training, this is 96

staff in total

A more tailored session is to be run for the PSA staff in April 2017

Feedback indicated the greatest value was gained from the experiential activities.

Outcomes of training

• Increased awareness of what it might be like for someone on

the ward with dementia through participation in activities.

• Improved knowledge of Non-pharmacological management

for BPSD.

• Improved knowledge of when to use medication

• Resources available to help support patients with cognitive

impairment

• A decrease in the incidence of reported aggression as staff

more equipped to work with BPSD

0

5

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not at allconfident 1

2 3 4 VeryConfident 5

Your knowledge of dementiaenables you to effectively supportpatients with cognitiveimpairment.

You feel able to successfullyanalyse acts of potentialaggression/tricky situations inclinical care.

You are familiar with strategies toreduce aggressive incidents

You are familiar with strategies tomanage aggressive incidents

You understand the role of themulitdisplionary apporach toproblem solving clinicalmanagement of cogntiivelyimpaired patients

0

5

10

15

20

25

30

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not at allconfident 1

2 3 4 VeryConfident 5

Pre and Post Confidence

Questionnaires

Pre Training Post Training

Challenges

- Completion and monitoring of online/ self

directed training

- Time and resource to register participants

and attend training

- Medical Team engagement

What’s Next

• Delayed post training questionnaires to be collected and collated.

• A detailed review of incidents of aggression over the past 6-12

months to see if there has been any change.

• Training to be rolled out across subacute with a slight variation in

content due to different resource availability. Tentative dates

have been booked for 2017 and will run every two months

commencing in April.

• Rollout in Acute Areas and Aged Psychiatry

Delirium Guidelines and CLOVER

• Development of Delirium Guidelines (CPG )

• Complete with Pharmacological algorithms

• All available electronically (Testing and Medications)

• Use of the 4AT as a screening tool (on admission) and through

out admission

• Research project found Drs are not good at filling in forms !

• At each ward round (Mon ,Wed ,Friday) or when a change in

Cognition

• Now printed on the back of ward round progress notes

The 4AT

♦ Takes only 1-2 minutes

♦ Suitable for use in normal clinical practice

♦ Practical and simple

♦ No special training is required

♦ Allows assessment of ‘untestable’ patients (that is, patients with

severe drowsiness or agitation)

♦ Includes brief cognitive tests

REF: Bellel l i G, Morandi A, Davis DH, Mazzola P, Turco R, Genti le S, Ryan T, Cash H, Guerini F, Torpi l l ies i T , Del Santo

F, Trabucchi M, Annoni G, MacLull ich AM. Validation of the 4AT, a new instrument for rapid delirium screening: a

study in 234 hospitalised older people. Age Ageing. 2014;43:496-502

Key features of the 4AT:

The 4AT

The 4AT is designed to be used by any health professional at first

contact with the patient, and at other times when delirium is

suspected. It incorporates the Months Backwards test and the

Abbreviated Mental Test - 4 (AMT4), which are short tests for

cognitive impairment. This provides basic cognitive testing, aimed

at detecting moderate-severe cognitive impairment, alongside

assessment for delirium.

4AT

1. Access the CLOVeR electronic chart for a patient

There they are ready to use!!

4. Select Powerplans - PH

And there they are ready to use

2. Select Orders + ADD from the Menu

3. Select Peninsula – Inpatient Orders

Initiatives

• Delirium Guidelines /4AT

• Passport to Care

• Pet Therapy Pals

• TOP 5

• Environment

Passport to Care

• RACFs –

• Consumers - carers of people with dementia and ID

• Peninsula Health Emergency staff

• Alzheimer's Australia (Vic) rep

• DBMAS representative

• Carer Respite Centre

• CDAMS

• MECAS

• CAPS-Baptcare

• Mornington Centre

• ROSS/HARP

Stakeholders of the Ageing Well Alliance

Passport to Care

This project delivers a person centred resource for consumers/carers of consumers with

cognitive impairment and disabilities . This document will be distributed in the community

and bought to hospital when the consumer is admitted

This document will benefit the consumers/staff caring for them in the following ways:

It will enable the staff to know more about the person thus enabling delivery of a more

“Person Centred” approach

Reduce the distress and impact of an Acute hospital admission for the person with cognitive

impairment /disability

Reduce the length of stay and functional decline for the person with cognitive impairment

/disability

Provide a “seamless service “ for the consumer/family

Project Summary

Pet therapy Pals

• By sponsoring a Pet Therapy Pal you are providing comfort and

companionship to a patient.

• Pet Therapy Pals are special weighted animals that can remind patients of

the feeling of holding and caring for an actual pet. Pet Therapy Pals keep

patients company or are just available for a cuddle when patients need one.

• When you sponsor a Pet Therapy Pal you give patients the gift of comfort.

When you do so, you will also receive a personalised sponsorship

certificate as a token of thanks on behalf of our patients.

• Pet therapy pals can be adopted via the Peninsula Health

Website: http://www.peninsulahealth.org.au/petpals/

TOP 5

• Top 5 is an approach to improving clinician and carer communication that was

developed by the Central Coast Local Health District in NSW

• Information shared by carers with Clinical Staff is recorded in the TOP 5 form

on the bedside chart actively used in Care delivery and conveyed to Clinicians

at Staff Handover

• The TOP 5 approach of Key strategies and the persona; history for the patient

with Dementia Embodies the heart of patient based approaches to care

• Ref :Cl in ica l Excel lence Commiss ion,2014.TOP 5 : improving the care of pat ients wi th Dement ia 2012 -2013 Sydney : Cl in ica l

Excel lence Commiss ion

TOP 5

TOP 5 • T- Talk to the person/carer

• O- Obtain the information

• P- Personalise the care

• 5 – 5 Strategies to assist

Other Initiatives (Acute Setting)

• IPOD Drive

• Environmental Changes to ACE ward (Signage, murals, door disguises)

• Non pharmacological intervention support –DBMAS funded $5,000

• Colored Toilet Seats in New Wards

•

Sub Acute Environment : 30 Beds Dementia Specific

Flinders ward

Thankyou !

**Special mention to Melissa Molenaar (subacute CNC ) who is on Long

Service leave and assisted in preparing this presentation !

Any Questions? Comments?