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THINK FRAILTY – the journey continues
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June Wylie
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Time Item Lead
13.30 Welcome June Wylie (Chair)
13.35 Overview of OPAC work stream and progress to date
Penny Bond
13.40 Patient/Family/Staff experience Rowan Wallace
13.55 Engagement with families. Patient, family & staff experience (from ASSET team and ACE nurses)
Trudi Marshall
14.10 Panel Discussion Trudie Marshall/Brian Mcgurn/ James MacWilliams/Dianne Coleman/Rowan Wallace/Lesley Herd
14.40 Close June Wylie (Chair)
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Penny Bond
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Think frailty - the journey continues.....
Improving care for older people in acute care
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Frail older people
•Have physical, cognitive and functional impairments
• Are often admitted with falls/immobility/ confusion due to significant underlying medical problems
• High risk of healthcare associated infection, delirium and under-nutrition in hospital
Why Frailty?
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Tools being tested: Locally adapted frailty triage tools and criteria
Aim: 95% of frail patients (within
test sites) have access to
comprehensive geriatric
assessment within 24 hours of
admission, by March 2014
Impact:
•Comprehensive Geriatric
Assessment carried out within 24
hours of admission
•Reduction in length of stay in
hospital
•Reduction in boarding/hospital
moves
•Improved patient experience
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Blurring of
boundaries - roles
Reduce LOS; Prevent
unnecessary admission
helpful to learn from
each other to improve
care delivery
Cross-sector working
& integration
Engaging families &
carers
Zero tolerance
for boarding
Identification of frail
older people is critical
Key messages
share
comprehensive
geriatric assessment
team work from
acute settings to
community hospitals
Dedicated unit for frail
elderly people with early
appropriate
treatment/discharge Right patient, right bed,
right time frame
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Focus on frailty
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@opachis
www.improvingcareforolderpeople.scot.nhs.uk
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Rowan Wallace
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Patient & Staff experience
Frail Older Person’s Pathway
NHS Ayrshire and Arran
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Pilot period • Aim; to focus on the pathway starting in A&E
and improve the patient experience for people over 65
• Pre pilot discussions with staff and patients/families
• What is important to the individual? What makes a difference? What needs to happen to demonstrate that the project is an improvement?
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The challenges
• A&E environment
• Difficult to predict when might be the best time to speak to patients
• Key stages of the journey
• Unable to rely on questions that have a basis in comparisons
• Measuring qualitative outcomes
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What we did
• Conversation rather than interviews
• Discussions with staff
• Emotion words
• Defining what is important to the individual
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How we did it
Observation
And Conversations
Staff /Team conversations
/comments
Patient/carer/family stories
Patient
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Emotional map - Staff
9 empty beds in 3E
Wards & CDU asked to be more
embedded in pathway
Feeling that it wasn’t as slick
today to begin with
Red dot process
Had time in wards to plan
discharges
Ward CNs to spend time in
ED
Feeling tired but keen to
get going
Admin co-ordinators role vital in
identifying issues with process
Best shift ever in 3E
Saw everyone that we needed to even though
went past cut off time
Much busier day but we managed
Overall busy day
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Emotional Map - Patients
A&E
Ward
Alternative to
admission
Home
Real benefit that
my father didn’t
need to be
admitted
A&E was an
experience – didn’t
like how busy it was.
More than I expected
– gold star
experience!
(interview in CDU)
10 out of 10, first class
service. Nothing to say
other than positive things
Great that my
husband could stay
with me
Scared that I
wouldn’t get home
Anxious
Initially I was concerned that
my mother was going home
from A&E but didn’t realise
what could be done to help
her at home
Going to a
step down
bed, not
sure what
that means
Great that I
am back
home, no
complaints
I was told that I
was going to a
72 hour bed –
that’s a relief to
know that I won’t
be in here for
long
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Reshaping Care
Feedback from Scottish Government public engagement events shows that people want to be able to live in their own homes for as long as possible
People want services to be personalised and delivered in a joined up way that offers continuity and meets their needs
(COSLA, NHS, Scottish Government 2011-2021)
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Mr Mc • 72 years old, lives at home with
son, who works shifts. His other son lives locally but works away from home for much of the week. Neighbour pops in a few times during the day.
• Went to pick up newspaper from behind front door, as he does every day. ‘Not sure what happened but fell and thought I had broken my leg’
• Ambulance called • Brought to A&E – FOPpathway
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Mr Mc contd. • Examined, X-ray, No fracture, Pain control
• Step down bed
• Visited to discuss experience
‘ I am pleased that I am here and not in Hospital. I know that I am not ready to go home and don’t want to be a burden on my son. I am in so much pain and don’t want to get up and try moving around. The Doctor explained that it would be better for me to be here and not in the hospital and that it was a shorter term thing, they expect me to be going back home....I’m delighted to hear that, I’m too young to be ‘looked after’ and still want to live in my own house’.
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Mr Mc contd.
• Visit at Home ‘I am feeling much better and happy to be back at home. The
whole experience was good, I enjoyed being in the step down place, they treated me so well and the Physio helped me to get up and moving again. I didn’t think that I would be able to do it but she told me what to do and helped me, if I was left on my own, I wouldn’t have even tried! I was worried that my son would have to give up work or I would end up in a home and that would be me........ I have my dog for company and can see to him myself, I can’t walk him but can do everything else’
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Lessons learned • People can be worried to give their opinions
whilst still in Hospital
• Family and Carers are often more outspoken
• Generally the care and treatment given is appreciated and there is a sympathy towards the staff in relation to workload
• Service and patient priorities can differ
• Timing of the discussions is important
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Trudi Marshall
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Trudi Marshall
Brian McGurn James
McWilliams
Rowan Wallace
Lesley Herd
Diane Coleman
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