1. Audit of Carer and Contacts documentation for Patients with Dementia Dr Jenny Finlayson, Banchory Medical Group 2014 Introduction Carers have a significant role to play in assisting dementia sufferers to manage at home, and can enable patients to remain in their own homes for longer. They have a key role as main contact and organiser for day-to day activities, appointments, medication etc, as well as offering emotional support and companionship. Many carers are partners or close relatives of the dementia sufferer and over time their input often increases. It can be a very challenging role and carers can sometimes feel isolated and unsupported. It is important to recognise the carers and support them, as well as having up-to-date contact information so contact can be easily co-ordinated. Identified as one of the eight Common Core Principles of Dementia (1), we should strive to ensure ‘Family members and other carers are valued, respected and supported, just like those they care for and are helped to gain access to dementia care advice’. Accurate and appropriate documentation of relevant information in GP notes, and where appropriate, Emergency Care Summary (ECS), can assist day-to-day management, both in- and out-of-hours, and enable the most appropriate management plans in both emergency and non-emergency situations. Anticipatory Care Plans (ACPs) also have a role to play in more complex cases. Emergency Care Summary (ECS) Documentation 15 patients had Anticipatory Care Plans (ACPs). There were 2 patients with ACPs who did not have KIS consent. One patient had a DNACPR documented (no ACP), however no KIS consent was recorded. Aims To audit all patients coded as having a dementia diagnosis, and who are living at home, to identify how carers are coded, both in patients’ and carers’ notes. Also to analyse how carer contacts are recorded in the notes, and whether relevant information is readily accessible, both in-hours, and if required, out-of-hours. Method A search was run for all patients coded as having a diagnosis of dementia, and a further search run for a sub-group living at home (ie. not in nursing / residential home or supported accommodation). A search was also run for these patients to identify who was coded as having a carer. Each set of notes was then analysed for :- 1. Coding of carer – what priority of coding was used 2. Recording of contacts for patient – was it in the correct contacts site ( notes therefore linked) 3. If no carer was coded, GP notes, dementia reviews and psychiatry letters were checked to identify if there was a carer but not documented 4. Partners / carers notes were checked to see if they were coded as being a carer 5. ECS details checked for both patients are carers to ensure KIS (Key Information Summary) consent had been recorded where appropriate. Findings A total of 113 patients were coded as having a diagnosis of dementia. 64 of these patients live at home, for whom the findings were as follows:- Carers 42 patients had carers, only 23 were coded as priority 1 (55%), 16 coded as priority 3 or 7 (35.5%) 4 were not coded at all (9.5%). 30 patients were carers, only 10 were coded as priority 1 (33%), 4 coded as priority 3 or 7 (14%), 16 were not coded at all (53%). Recording of contact details for patients with carers / patients who are carers within the practice (Total = 30) Patients with contacts correctly listed / notes linked = 14 (46.6%) Patients with contacts incorrectly listed / on yellow sticky / incomplete = 5 (16.7%) Patients who have carers but details not documented = 11 (36.7%) Results showed an under-recording of dementia patients with carers, and a variation in how these were coded. There was a significantly higher under-recording of patients who were carers, and again some variation in how these were coded. There were variable sites in the notes that contact details were recorded, with subsequent reduction in linking of patients notes (carer / dementia patient), as well as some missing carer data in ECS information. The absence of KIS consent in some notes meant that details / ACPs recorded by the GP for Out-of-Hours information was unavailable to the Out-of-Hours service. Conclusions To improve our care for dementia patients and their carers, coding of carers for dementia patients in the practice needs to be more consistent. Similarly for patients who act as carers for dementia patients. Coding in both cases should be Priority 1, so it can be seen in the patient’s summary. Documentation of carer details should be recorded consistently in the correct place so that information is easily accessible / notes are linked for use during day-to-day general practice, and so that carer information is readily accessible where KIS consent has been given for Out-of-Hours services. For patients with ACPs or other ECS relevant information, KIS consent must be organised so that relevant information is accessible to Out-of-Hours services. Applications to practice Guidance has been given to practice staff regarding the documentation and coding of carers, in particular for dementia reviews as many dementia patients had carers added to the notes at this point, usually as a priority 3, but rarely adding the carer as such in their notes. Similarly, regarding the area for documentation of carer’s details – administration staff will also be involve in this to ensure this is correctly recorded. A reminder has been given regarding the importance of KIS consent for relevant patients. Information will be cascaded to staff regarding the significance of the carer role and ways in which we can help support both patient and carer, for example contact with Alzheimer's Scotland. Personal Learning from Dementia Scholarship The scholarship has covered a great breadth of information about dementia and allowed me to gain a significantly greater understanding of diagnosis, medications, management of behaviour that challenges, the role of scanning, and the legal aspects around dementia. By having the opportunity to job shadow colleagues in Old Age Psychiatry and Radiology I have gained a very useful insight in the assessment and longer term management of this important condition in the community. References 1. Common core principles for supporting people with dementia: a guide to training the social care and health workforce. Policy – Treating patients and service users with respect, dignity and compassion. Department of Health 9.6.2011. www.gov.uk/government/publications