Maureen Strudwick & Tony Phiskie Carer Support Units CCLHN & SWSLHN March 2011 TOP 5 – Engaging CALD carers to personalise hospital care for people with cognitive impairment

TOP 5 What is TOP 5 Pilot Study Implementation Evaluation

What is TOP 5? A process to –identify & engage the carer of a patient with cognitive impairment. –negotiate and record up to five carer “strategies” that promote person-centred care and communication on the ward.

Where is TOP 5 located? –Strategies are documented and located on the bed chart. –an I.D. tag is placed on the top of the chart –a sticker is placed on the spine of the medical record.

TOP 5 is person-centred practice which Recognises the importance of engaging carers. Values their knowledge, expertise and tips in caring for their care recipient. Effectively communicates carer’s information across sectors, people, systems. Creates a more settled and comfortable environment Reduces incidents of adverse events

TOP 5 Pilot 4 Acute Care Wards were targetted for 8 week Top 5 pilot Top 5 Champions were sought and trained Staff and Carers were surveyed pre and post pilot Staff were trained in carer role, and carer engagement

Top 5 Pilot Study Results Staff reported patients to have: a quicker recovery less agitation, frustration and distress more effective communication increased ability to relate

Top 5 Pilot Study Results Carers noted staff to: have increased awareness of their role (58% to 90%) invite them to share patient information (54% - 89%) listen and take on what they shared (54% - 72%)

TOP 5 Implementation Gain support Address Issues Communicate Gains

Gain support Establish partners : –Ward leaders - NUMs, CNCs, CNEs, –Delirium & Dementia CNC –Ward ‘champion’ for “Carers as Partners in Care”

Address Issues Resistance to “yet another thing to do” –Create confidence in the process using “champions” to model the process and to coach their peers, –Demonstrate value of TOP 5 by using feedback at ‘handover’ and case conferences –Embed TOP 5 in protocols for ward admissions, falls prevention, and delirium detection.

Communicate Gains Wins for all parties – Reduced incidence of adverse events – Reduced length of hospital stay – Improved safety for patients, and staff – Improved staff/patient & staff/carer relationships

TOP 5 Evaluation hospital wards in the CCLHN were included in the survey 64 Staff members included 43 nurses, 9 ward nursing executive, 2 medical and 10 allied health staff were interviewed

TOP 5 Evaluation Results 93% of staff were aware of Top 5 91% of staff reported Top 5 strategies benefit the patient 98% of nurses reported Top 5 strategies benefit them in nursing the patient 98% of staff said they would recommend Top 5 to colleagues and other health professionals

TOP 5 Evaluation Staff Comments: –“Highly recommend it” –“A great initiative” –“Makes my job easier” –“Less pressure, helps with knowing a patient” –“Easy to use” –“Very effective” –“Really good resource tool, promotes patient comfort”

TOP 5 for CALD Carers Getting Started in SSWAHS Lessons Learnt

Interest in TOP 5 in SSWAHS Carer from SSWAHS Community Participation Network had heard Maureen’s presentation at 09 Conference –Raised as agenda item at CAP committee Sep 09 Resolved to investigated interest in Top 5 –Carers’ Program sent names of “interested parties” Meeting of “interested parties” called for Oct 09

Carers’ Program, SSWAHS investigate TOP 5 EOIs asked from potential Top 5 sites More info sought from CSU, NSCCAHS I attended Dementia Café Maureen invited to present TOP 5 promoted on Intranet Bulletin Board (Home Page) Overwhelming response – 85 rsvps

NUM Quote on interest in TOP 5 “What appeals to me is the simplicity of the initiative and the simplicity of the actual Top 5 page that will go in the patients bed chart.... and the absence of the 25 page instruction manual; mandatory one day education; policy requirements; mandatory education about the policy; the mandatory monthly data reporting; and mandatory training on the mandatory monthly reporting data.”

Concerns by Carers Program No dedicated staff member to oversee project Is current context appropriate to embed TOP 5 –Budget –Staff shortages –Introduction of LHNs

Incorporating CALD Population Liverpool Aged Care Unit have developed resources for CALD patients and Carers. CNE of Liverpool ACU attended first planning meeting & Maureen’s seminar and raised issue of Carers Program of CALD carers Close to 50% of patients in Aged Care Unit from CALD backgrounds

CALD Population in SSWAHS the most culturally diverse populations in NSW live within the Sydney & SWS LHNs 40% speak LOE at home (26% in NSW) 60% in Fairfield and Canterbury Greatest no. speaking LOE at home: –Arabic, Vietnamese, Cantonese, Italian & Greek

CALD Population in Liverpool SSWAHS Translation and Language Service Identified 5 major community languages in Liverpool LGA: Arabic, Chinese, Serbian, Spanish, Vietnamese Translated TOP 5 resources into Community Languages –The brochure on Top 5 –The pre and post Top 5 evaluation surveys

Establishing commitment Meeting of interested staff (April 2010) – good response 20 staff representing Balmain, Bankstown, Bowral, Camden, Campbelltown, Liverpool. Braeside (Fairfield Aged Care), Fairfield Hospital and Concord hospital also expressed interest. Outlined what the Carers Program could offer in way of support and funding for CALD resources Developed a process for getting things started.

The process begins …. Staff went back to their workplaces to garner local support for TOP 5 Essential that Working Groups established at each site Balmain, Bowral, Braeside, Camden, Liverpool, Fairfield ISSUE: Lot of interest BUT Carer Program unable to provide backing at the rate of rollout.

Working Groups established…. Carers Program letter to facility administrations TOP 5 processes established: –Training of Staff –Development of Manual –Starting date Staff trained at each site –Balmain – all wards –Camden – Medical Transit Unit –Liverpool – aged care wards

CALD Patients and Carers Clinicians identifying CALD patients and carers receiving ‘less than’ service –Use of interpreters –Communication issues –Requires greater staff effort for same result with patient –Cultural differences around the role of family and carer –Religious beliefs, superstitions –Variations in translation of English

Research Confirms Clinicians Experience Local and National research has established access barriers for CALD Carers: –Difficulties with language –Lack of knowledge of services –Lack of culturally & linguistically appropriate services & assessment for their carees

Local Focus Group Research Aged Care Research Unit, Liverpool Hospital Not speaking English was a major issue in communication of information Need for Dementia education for CALD & broader community Hospitalisation noted as a factor in the decline in condition of PWD Comments on Dementia care in Dr’s surgeries, Day Care Centres, Residential Care facilities and Community Services. Lack of understanding & culturally appropriate care in hospitals

Instigating TOP 5 with CALD Carers WHO? –Nursing are 24 hours, 7 days a week –Nurses have specific high priority protocols that MUST be followed prior to end of each shift –Nursing has competing demands on time, energy, and mental space BUT TOP 5 WILL START OR FINISH ON THE WARD

Instigating TOP 5 with CALD Carers con’t TIME –Arranging time with carer –Booking interpreters –Time-poor Nursing staff looking at longer time to work with CALD carers –Cultural differences impact on relationship between carers and staff

Feedback Essential Staff need to know that Top 5 is worth the effort Limited day-to-day involvement Carers’ Program Local data collection – CALD Carer specific

Lessons Learnt Need for a dedicated project worker to support working parties Engage Geriatricians Working Parties need to be endorsed formally by executive Definite commitment by nursing administration Working Parties staff training must include engaging and communicating with CALD carers Involvement of “community”

…and more lessons … Establishing Worth & Good Will Hospitals Networks – hospital and community networks Working groups LHN Executive Community –General Aged Care –CALD groups

REFERENCES NSWHealth “Carer Action Plan 2007 – 2012” Alzheimer’s Australia Victoria “Perceptions of Dementia in Ethnic Communities “ October NSWHealth “Easy Guide to Clinical Practice Improvement” 2002 Foreman, P & Gardner, I. (2005). Evaluation of Education and training of staff in dementia care and management in acute settings. Melbourne: Victorian Department of Human Services Web references: