2. DEMENTIA Positive Solutions In Acute Care Priscilla Taylor Clinical Nurse Specialist Benalla & District Memorial Hospital North East Victoria

3. Admission Stressful Patient Carers Staff

4. Raw Deal… Lack of: - Time Patience Resources Staff confidence

5. Others Factors Staff inexperience Complex needs Behaviour Lack of “fit”

6. Benalla & District Memorial Hospital 85 bed rural facility 31 bed Medical Unit 24 bed Mid/Surg/DSU 30 bed Nursing Home

7. Caring For Dementia Patients Searching for solutions

8. AIMS Safe Environment Anxiety Free

9. Where Did We Start? Total Dementia Bed Days: Mar 2003 - 109 June 2003 - 180 April 2003 - 166 July 2003 - 221 May 2003 - 192Aug 2003 - 178

10. Where Did We Start? cont. Average Monthly Bed Days = 175 50% prone to wandering Jan ’05 dementia patients = 26% of total bed days

11. Analysis Effect on Casemix - funding 44% NOT recognised in diagnosis

12. Analysis cont. Casemix Funding Allocation Average allocation =$2189 Dementia conditions=$8885

13. What Followed…  Education  Information Search Seminars Reading Compilation of Resource Folder

14. Safe Environment Installation of Alarm System

15. Safe Environment cont. Hip Protectors Use of Signs

16. This Is Your Life Book… Permission granted by Alzheimer’s Association of Victoria

17. This is your life…  Past interests & hobbies  Present skills  Favourite music & TV programs  Special friends and pets

18. Thanks to Bendigo Health for use of their “Communication with Dementia Clients” Pamphlet. Do’s & Dont’s of Dealing With Dementia

19. Dementia Care Pathway Directs staff Tools Assessments Thanks to Bendigo Health for use of their Dementia Care Pathway

20. Diversional Therapy MUSIC

21. MUSIC cont. Emotional wellbeing Communication Behaviour Management Sleep

22. Other Diversional Therapies  Old movies  Memorabilia  Reminiscences  Craft/games  Touch/tactile/comfort objects  Utilization of previous skills

23. Old Movies

24. Memorabilia

25. Reminiscing

27. Craft and Memory Games

28. Tactile Diversion

29. Utilizing Previous Skills

30. Strategies For Restless Hands

31. IV Line Decoy Part I

32. IV Line Decoy Part II

33. Occupying Restless Hands

34. The Benefits Equally valued Soothe symptoms Relieve apprehension Less Staff Stress Excellent Resource Info

35. The Benefits Continue Dementia pathway & flow charts Education/Personal development Support and involvement Positive feedback

36. Flexibility of Staff Allocating workloads Minimise disruption

37. STAFF SATISFACTION SURVEY “There is less aggression” “The wandering alarm is the best thing the hospital has implemented, it gives me confidence to go about my other nursing tasks knowing that I will be alerted if a patient with an alarm attempts to leave” “Patient’s faces light up when you know a bit about their past and their hobbies” “Family members statements of …relief, impressed, reassuring and pleasantly surprised”

38. STAFF SATISFACTION SURVEY CONT. “Lady with dementia fondly held and talked to her stuffed toy dog; the man who spent hours looking at old magazines; the lady who many times watched old movies and dancing on videos; the man who spent ages soaking stamps off envelopes; the IV site decoy was pulled, poked and played with but the IV remained insitu”

39. STAFF SATISFACTION SURVEY CONT. If you were asked to look after only the more ambulant patients with dementia for a full shift, would you be willing to do so now that we have these strategies in place? UNSURE - 3 NO RESPONSE - 2 YES -12 NO - 1

40. This Project Is…. Grass roots Sustainable Highly successful Replicable Everyone benefits

42. BDMH Board and Management Jenny Bickerdike, NUM, BDMH Matt Gill, Discharge Planner, BDMH Clients and Family members. Bendigo Health Alzheimer’s Association of Victoria Acknowledgements