september 25, 2007 implementing best practice guidelines for delirium, dementia and depression: a...

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA

AND DEPRESSION: A CITY-WIDE APPROACH

Laurie McKellar RN(EC), BScNNurse Practitioner on Geriatric Consult - Liaison Team,

St. Joseph’s Health Care London (SJHC) and London Health Sciences Centre (LHSC)

Ann Jarvie RN, MScNClinical Nurse Specialist, Regional Psychogeriatric Program

Parkwood Hospital - St. Joseph’s Health Centre

for the

The London 3Ds Group

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA

AND DEPRESSION: A CITY-WIDE APPROACH

Declaration:

There are no conflict(s) of interest thathave a direct bearing on the subject matter of this presentation.

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

RNAO Best PracticeSpotlight Organization Are health-care organizations selected by the Registered Nurses’ Association of Ontario (RNAO) through a Request for Proposals process to implement, evaluate and share lessons learned from their guideline experiences and research findings.

• In March 2006 both LHSC and SJHC were selected to be Best Practice Spotlight Organizations (candidate)

• LHSC committed to implement the RNAO Best Practice Guideline ‘Screening for Delirium, Depression and Dementia in Older Adults’

• SJHC committed to implement the RNAO Best Practice Guideline ‘Caregiving Strategies for Older Adults with Delirium, Dementia and Depression’

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

• London Health Sciences Centre (LHSC)

Medicine Program Units

at University Hospital

and Victoria Hospital• Acute Medicine

• Family/Palliative Care Medicine

• Acute Care of the Elderly

• Respirology Medicine

• Medicine Triage Unit

• St Joseph’s Health Care- London (SJHC)

Rehabilitation Units GRU/MSK at Parkwood Site

Long Term Care Unit Veterans Care at Western Counties Wing at Parkwood Site

Geriatric Mental Health

Unit L1 at Regional Mental Health

Care London

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

• London 3 D’s Group

– APN’s from both organizations met to consider participating in a research project as an RNAO Best Practice Spotlight Organization (candidate)

– Group expanded and met in June, 2006 to discuss an opportunity to jointly participate in this research project about the 3Ds

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

• London 3 D’s Group

– Group decided that it was premature to do research

– London 3D Group formed

Members are from:

- multiple disciplines - multiple roles - several of the implementing Units

September 25, 2007

As the interdisciplinary London 3Ds Groupcontinues to evolve, the following

outcomes have been achieved:

• Group consensus to use an interdisciplinary city-wide approach to implement the 3Ds BPGs (RNAO & CCSMH Guidelines) in SJHC and LHSC to enhance consistency in elder care and to minimize gaps.

• Commitment to engage in research in the future

• Visioning exercise & development of a logic model

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

• Implementation Activities

– Partnering with RNAO to develop E-learning

– Developing curriculum content (from RNAO and CCSMH guidelines) for face to face education sessions with staff

– Meeting with unit leaders to develop a process to implement the guidelines

– Developing an evaluation process

September 25, 2007

IMPLEMENTING BEST PRACTICE GUIDELINES FOR DELIRIUM, DEMENTIA AND DEPRESSION:

A CITY-WIDE APPROACH

• Why are we doing this?

• To build healthcare providers skill, knowledge, comfort and confidence re:3Ds

• To improve more accurate and earlier diagnosis on the 3Ds

• To improve safety of patients, family and staff

• To decrease mortality and morbidity associated with the 3Ds through early diagnosis

• To improve Elder Care