Activities in HospitalsActivities in Hospitals

Dr Lesley YoungConsultant Geriatrician

Sunderland Royal Hospital

Sunderland Royal HospitalLarge DGH in the north

of England855 beds including ~150

acute Care of the Elderly>30,000 admissions/yr

Sub regional centreHistorically a ship

building and mining townPopulation is mainly

white British, high levels of social deprivation and co-morbidity

Highly computerised system

Our journey in improving dementia care in hospitalPrior to 2010

V limited liaison old age psychiatry (1 nurse)Low priority for Trust

Poor performance in 2010 NADApril 2012:

UK government introduce National Dementia CQUIN

Oct 2012:Business case for dementia approved by Exec

board, IF we guaranteed to meet CQUIN

Summer 2013-2015Appointment of new team with in Elderly Care

department (Delirium Dementia Outreach Team):4x band 7 practitioners (3 senior nurses + 1 physio)½ WTE senior pharmacist½ band 3 adminSupervision from 1 ½ Consultant geriatricians

Monitor and ensure compliance with dementia CQUINProactive identification of patients with cognitive

frailty at the front doorProvide a hospital wide delirium serviceMeet policy expectations

Evidence and policy baseNICE Dementia guideline 43

Promoting independence and maintaining function Structured group cognitive stimulation

Interventions for non-cognitive symptoms and behaviour that challenges Aromatherapy Therapeutic use of music/dance Animal assisted therapy Massage Exercise

Evidence and policy baseNICE Delirium guideline 103

1.1 identify those at risk >65, cognitive impairment, hip fracture, sever illness

1.2 identify prevalent delirium1.3 Interventions to prevent delirium

1.3.3.1 introducing cognitively stimulating activities 1.3.3.2 address dehydration 1.3.3.5 address immobility by encouraging active range

of motion exercises 1.5 diagnosis

1.6Treating delirium 1.6.2 ensuring effective communication and

reorientation, providing a suitable care environment 1.6.3 de-escalation

Pull and push¾ patient seen by DDOT are identified

proactively from screening (PULL)Open referral system via phone call or bleep

for any health care professional with concerns about delirium or dementia in a patient (PUSH)

DDOT reviewIdentify nature of cognitive problemAdvice on investigation and management of

deliriumIncluding medication review

Advise on delirium preventionObtain collateral history by liaising with carersLiaise with MHLT to obtain previous MH historyOrganise onward referral where appropriate to

MHLT / CMHT / GP for formal diagnosis of dementia

Send letter to GP to advise of cognitive issues during admission

Arrange follow upDDOT FU clinic running since November 2014

DDOT Activity

April 2015: Alexandra centre

Day therapy area for cognitively frail in-patients

In reach – out reach service to wards

Dementia friendly design, using Stirling university tool

Alexandra centrePatients identified by DDOTMorning and afternoon therapeutic

activity sessionsPatients invited to come from wardsActivity + lunch or afternoon tea in social

setting

Alexandra centreOutreach to wards for patients unable to come to centre

Trolley with diversional activitiesAbility to offer 1:1 careAssistance with mealsPromoting independence

• Dip in service provision seen in July with loss of member of staff.• Dip in service provision in September due to short staffing on wards

Alexandra CentreInformation resource for staff and carers

Open access leaflet areaDrop in sessions for voluntary agencies

Staff feedbackSurvey of ward sisters and matrons58% response rateAll were aware DDOT and had received

input from team (56% on a daily basis)All felt it was helpful (84% very)

95% were aware of the Alexandra centre and 84% had used it (48% at least weekly)All felt it was helpful (79% very)

Staff feedback

0102030405060708090

100

1 to 1 nursing security falls sedation

increased no impact decreased

Subjective view of ward staff on impact of DDOT and Alexandra centre

• Actual in patient falls reduced by 28% April/May 2015 compared to April/May 2014

Patient Feedback

I look forward to the pink ladies. I know I am in for a treat

Audrey enjoyed the dancing and would enjoy coming again

I am very happy to see Bill settle and enjoy himself

mum says she loves coming to this centre

Makes such a difference to those with dementia

What a great idea. Dad enjoyed himself, as daughters we have enjoyed seeing him enjoy it

The teamDr Lesley YoungDr Emily LyonMatron June LawsonSpecialist PharmacistELSP

Chris CairnsJackie LynchClaire KhanAndrea HintonClaire BoylanLeanne McGough

HELPAsRachel Knowles

(PT)Pat AllenMoira KennedyJessica SmithEmily ChapmanTanya TaylorBev Thompson

(PT)

Thank youAny Questions?

Lesley.young@chsft.nhs.uk