1. Service Model Algorithm
Making dementia a priority at the front door; a Dementia Champion project within AHP Acute services
Louise Watson, Occupational Therapy Professional Lead, Acute Division, NHS Greater Glasgow and Clyde -
Christine Steel, AHP Consultant (Dementia), NHS Greater Glasgow and Clyde -
Shona Ballentyne, Practice Development Occupational Therapist, Acute Division, NHS Greater Glasgow & Clyde
Introduction
In 2011, the Scottish Government published the Promoting Excellence Document which detailed Quality of Life indicators for people with Dementia (1).
As part of a NES Dementia Champion project, five of these indicators, clarified by Waugh et al, in the supporting change booklet (2), were used to evaluate the current Occupational therapy and Physiotherapy (OT and PT) service within the acute medical receiving units across NHS Greater Glasgow and Clyde (NHS GG&C)
Findings
The following points were discussed during the evaluation session.
Staff highlighted that an increased support and training could improve their knowledge in supporting patients with challenging behaviour.
Staff felt that there were currently areas of good practice but they were concerned that they may not be using a consistent and best practice approach.
Staff reported that due to caseload pressures and often lack of confidence in assessment skills this patient group were often viewed as low priority and admitted for further assessment.
Staff acknowledged that this approach was not patient centred. (Scot. Gov. 2010)(4)
Staff described how an algorithm or guidance sheet may support a consistent approach to the screening of patients with cognitive impairment within acute medical receiving 7 day service.
Outcome
Based on the findings from the discussion in the evaluation session it was agreed that;
Training will be provided to staff, to enhance the knowledge and confidence in working with this patient group. The training will be based on Module 4 training from the Dementia Skilled – improving practice learning resource (5)
A service model algorithm would be developed to ensure a consistent approach could be taught and utilised across GG&C.
Service Model Algorithm
Aims
To evaluate the elements of good practice as outlined in the supporting change booklet (2) with OT and PT staff in acute medical receiving units across GG&C.
To review and address the learning needs of the staff in this clinical area.
Full social history gained from patient or family, identify if “Getting to know me” document is available, commence where appropriate
Describe and discuss with medical admission team the normal routine and functional level of ability for patient
Where patient is medically stable review functional abilities with involvement from family/carer as appropriate
If medical staff planning to admit, discuss if home with support an option. If admission required for ongoing medical intervention, provide plan for AHP involvement to facilitate discharge at earliest opportunity
Ensure AHP staff at receiving ward is alerted to patients needs and action ASAP/link with Elderly Care Assessment Nurse/Bed Manager to ensure move to correct ward
Patient has confirmed diagnosis of dementia or family/patient reporting concerns over cognitive impairment
Method
The evaluation used an appreciative enquiry approach (Cooperrider et al 2008) (3)
Senior Occupational Therapy and Physiotherapy staff working within acute medical receiving in GG&C were invited to take part in a discussion group.
A brief questionnaire was issued to staff involved to set the themes for discussion,
Staff were asked;
How confident they felt working with patients who have cognitive impairment and what support they felt they needed to increase their confidence?
2. Whether they had completed the learn pro module on Dementia Awareness or any other training?
3. What factors influence referral and prioritisation of a patient with cognitive impairment?
4. If they had any other comments in relation to providing a quality service to this patient group.
Next Steps…
Although challenging, it is vital that this process of implementing the training and algorithm is a priority for the OT/PT teams working within medical specialities across GG&C to ensure a quality service for this patient group at the earliest possible point of admission to hospital.
Future evaluation will be conducted using the appreciative enquiry approach. The service will be bench marked against the same indicators to allow staff to reflect on areas of continued good practice and further areas for improvement. Ongoing review will seek to embed this positive approach into the everyday practice of this staff group.
Consideration is also being given on methods of collating patient/carer feedback and potential use of emotional touch points (Dewar et al 2009) as a method of engaging with this patient group. This will add further quality of knowledge and understanding to guide the best practice of OT/PT staff working alongside people with dementia and their carers.
References
Scottish Government (2011a) Promoting Excellence, Available at
Waugh A, Marland G, Sharp B, Henderson J, Kydd A, Waugh J (2011) Supporting Change, University of the West of Scotland
Cooperrider DL, Whitney D, Stavros J (2008) Appreciative Inquiry Handbook for Leaders of Change, 2nd Edition, Crown Custom Publishing, Ohio
4. Scottish Government (2010) Scotland’s National Dementia Strategy, Available at
5. NHS Education Scotland (2012) Dementia Skilled – Improving Practice Learning Resource, Available at