1. Implementing a Hospital Dementia and Delirium Care with Volunteers Program
Thank you for the introduction Cathie and good morning everyone – it is great to be part of this years symposium. I am going to start the session with a short overview of the program and our outcomes to date.
Frances will then talk about some of her experiences as a volunteer with the Eurobodalla Dementia and Delirium Care Volunteer program
Before I start, I would like to acknowledge my colleagues and fellow researchers in the Aged Care Evaluation Unit – Katrina Anderson and Annaliese Blair
Cath Bateman RN Ma Nursing (Research)
Dementia Delirium Clinical Nurse Consultant

2. Context
Older patients with dementia and/or delirium are at far greater risk of adverse events and outcomes such as falls & pressure injury
Patients with confusion can experience significant fear, stress and anxiety when admitted to the busy, noisy hospital environment. This in turn can pose particular challenges and stresses for staff and family carers

3. Aim of the program
To provide person centred emotional support and practical assistance to patients with dementia and delirium (or those patients with identified risk factors for delirium) to reduce their risk of adverse outcomes
Volunteer role similar to that of a family carer

4. Structure of the program
Recruited and trained volunteers provide person centred emotional support and practical assistance such as assisting with eating and drinking
Personal profile used to identify individual preferences
Volunteers provide two shifts over 5 days. Morning shift 8am – and evening 3pm – 7pm
Formal referral process by staff and volunteers have their own documentation and communication process
Volunteers are part of the care team and identified by a gold polo t-shirt

5. The beginning
Pilot project implemented at Bega hospital in 2009 in partnership with Alzheimer’s NSW. This program continues
Results of pilot
Trend towards a reduction in falls
Volunteers - greater confidence in care post program f(1.5, )=11.78, p=.001 and increased positive PCC attitudes post program f(1.4, 19.6)=13.54, p=.001
High acceptability by nursing staff and volunteers with perceptions of improved safety and quality of care for patients
Anecdotal evidence of support for family carers
By way of background, the original inception of this program started at Bega Hospital in My colleague Barbara Williams and I established the program and ran the training together while I conducted research on the outcomes and formulated the program procedures.
The results of this pilot showed a trend towards reduced falls, greater confidence in care and improved PCC knowledge and attitudes for the volunteers.
The program was highly accepted by staff with perceptions of improved safety and quality of care - particularly related to hydration and nutrition and emotional care.
Although carer feedback was not measured – there was anecdotal evidence of volunteers providing positive support for family carers
This program continues and is now in its 8th year

6. Program growth
Model included in NSW Dementia Services Framework and Implementation Plan
Showcased on innovations exchange sites in United States and Australia
Replication in other Australian Hospitals
Included as a resource on the ACSQHC Caring for Cognitive Impairment Campaign
Further roll out and research occurring
In recognition of the benefits of this volunteer program for patients with dementia, the program was included as a model supporting acute care of patient with dementia in the NSW Dementia Services Framework
Then in 2014 the NSW Agency for Clinical Innovation under their Care of Confused Hospitalised Older Persons program funded the development of an implementation and training resource to facilitate other hospitals wishing to implement the program. This resources was developed locally with the support of local clinicians, service providers and volunteer actors – a number who are here today. There have been over 80 requests for the hard copy and now electronic resource from NSW, other states and internationally
Then last year the Australian Commission on Safety and Quality in Health Care included a link to the resource on their Caring for Cognitive Impairment Campaign web site

7. The Volunteer Dementia and Delirium Care Implementation and Training resource
2014 – NSW Agency for Clinical Innovation (ACI) under the Care of Confused Hospitalised Older Person Program (CHOPs) funded the development of a training and implementation package to support further roll out in NSW
Now a web based resource:

8. Key considerations in implementation of the program
A governance structure with a designated project lead is essential for successful and sustainable implementation
Using a project management framework
Ongoing Volunteer Manager or Coordinator is required for volunteer recruitment, screening and vaccination, coordination of training, support and management post project implementation

9. Evaluation and monitoring
Governance
Project implementation committee
Communication and reporting
Stakeholders
Evaluation and monitoring
Measures and feedback processes
Patient, carer, staff, volunteers
Planning
Program procedures
Resources – patient activity, volunteer
Staff awareness – roles and boundaries
Volunteer recruitment, vaccination and training

10. Screening, vaccination
Recruitment
Promotion – media
Screening, vaccination
Training
Training resources
Other presenters, venue, catering
Mandatory training
Commencement
Orientation
Rostering
First shift support

11. Additional resource considerations
Catering for volunteer training
The purchase and supply of the volunteer uniform
Allocated volunteer space on ward with filing cabinet, desk and chair space
Patient activity resources to support therapeutic activities as well as distraction resources for agitated patients. A list of suggested activity resources is included in the implementation guide
Secure storage for patient activity resources
Partnering with other health service fund raising groups such as Hospital Auxiliary’s can assist in accessing funding for the patients activity resources.

12. Planning and conducting staff information and education sessions
Positive promotion – be innovative
Focus on roles and boundaries

13. Other Key considerations:
Establishing volunteer networking and feedback processes
Volunteers can positively contribute to program improvements and changes
Ensuring staff feedback processes are in place and address any issues early

14. Final steps
Ongoing volunteer mentoring, support, feedback and recognition
Determining ongoing rostering and recruitment responsibilities
Monitoring the implementation
Conducting the evaluation
Continuous quality improvement and ongoing program governance

15. Be prepared for challenges
Staff resistance
Unrealistic expectations of the volunteer role
Delays with recruitment and vaccination
Volunteer counselling and management
Success is not final, failure is not fatal: it is the courage to continue that counts (Winston Churchill)

16. Acknowledgements NSW Agency for Clinical Innovation
Barbara Williams – Alzheimer’s Australia
Mike Bird, Katrina Anderson & Annaliese Blair
Brigid Crosbie, Peter Davis, Kirsty Herbert, Chantelle Tiskins
Bega Hospital staff and volunteer actors
The many wonderful and dedicated volunteers

17. Questions?