DEMENTIA Positive Solutions In Acute Care Priscilla Taylor

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

Admission • Stressful • Patient • Carers • Staff

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

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

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

Caring For Dementia Patients Searching for solutions

AIMS • Safe Environment • Anxiety Free

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

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

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

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

What Followed… § Education • Seminars • Reading § Information Search • Compilation of Resource Folder

Safe Environment Installation of Alarm System

Safe Environment cont. • Hip Protectors • Use of Signs

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

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

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

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

Diversional Therapy MUSIC

MUSIC cont. • Emotional wellbeing • Communication • Behaviour Management • Sleep

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

Old Movies

Memorabilia

Reminiscing

Craft and Memory Games

Tactile Diversion

Utilizing Previous Skills

Strategies For Restless Hands

IV Line Decoy Part I

IV Line Decoy Part II

Occupying Restless Hands

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

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

Flexibility of Staff • Allocating workloads • Minimise disruption

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”

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”

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? NO - 1 NO RESPONSE - 2 UNSURE - 3 YES - 12

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

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