dementia: primary care guidance sheet - g-care.glos.nhs.uk · [email protected] dementia lead...
TRANSCRIPT
Dementia: Primary Care Guidance Sheet
Living WellSocial Prescribing,Age UK: www.ageuk.org.uk/gloucestershire Tel: 01452 422660
Concerns about MemoryInformation, advice and Education sessionsMM 2gether: for people worried about their memory:Contact: 0800694 8800 [email protected]’s Society contact: 01452 525222
Diagnosis & SupportGP supported to diagnose non-complex dementia Community Dementia Nurse (Practice allocated) orTalk with CDN or Contact: 0800 694 8800. [email protected] For specialist support in complex diagnosisMemory Assessment Service: 0800 694 8800 [email protected]
Use Gloucestershire’s G-Care for information to aid diagnosis and guidance re support and medication:‘G’-Care: http://g-care.glos.nhs.uk/pathway/21/resource/3
When Dementia is DiagnosedProvide: ‘This is me’ document’ - Download from Alzheimer’s Society website: www.alzheimers.org.uk/countingthecost Refer to Dementia Advisor. Tel: 01452 525222Offer ‘Advance Care Planning’ document Refer to MM2gether group information sessions (for carers of people with dementia & people with dementia) Tel: 0800 6948800Offer information about Join Dementia Research: (JDR)www.joindementiaresearch.nihr.ac.uk/
Maintaining Well-Being & Living Well Signpost to Community Based Support: eg Memory CafesDementia Advisers (Alzheimer’s Society): 01452 525222Carers Gloucestershire: 01452 386283
Managing Acute & Complex Conditions Link with:CDN’s: Brief Intervention work: Tel: 0800 694 8800 [email protected] CDN (if acute but non urgent with low risks). Mental Health Liaison Team (if in hospital)2gether One Stop Team, Later Life: 08000 151 499 Referrals to: [email protected] Home Support Team (if in care home): 08000 151 499
End of Life & Bereavement SupportLink with Gloucestershire’s: Dementia Link Workersin all health and social care organisationsConsider use of Best Interest Tool (document) for advanced dementia
Rockwood
Frailty Scale
1Very Fit
2Well
3Managing
Well
4Vulnerable
5MildlyFrail
6Moderately
Frail
7Severely
Frail
8Very Severely
Frail
9Terminally
Ill
‘I’m worried about my memory’
‘I was diagnosed in a timely way’
I‘Il get the treatment & support that are
best for my dementia, my life’
‘I am treated with respect and
dignity’
‘Those around me are well supported’
‘I am confident my end of life wishes
will be respected. I can expect a good death’
‘I understand so I make good
decisions and have opportunities for future planning’
The Dementia Training & Education Strategy for Gloucestershire
Level 1Mapped to:
Health Education England
Tier 1 Outcomes
Care Certificate Standard
Standard 9 (Dementia)
Common Core Principles
1,2,3,4,5,6,7,9
Community Dementia Links
How to book:
Contact: Sue Keane
Local Train the Trainer
Contact: Sue Keane
Kwango E.LearningSCIE E.Learning
How to book KWANGO:[email protected]
for user names and passwords
SCIE E-Learning Resource at:http://www.scie.org.uk/dementia/open-
dementia-e-learning-programme/
DEMENTIA TRAINING PATHWAYFor Initial inquiries/information please contact: [email protected]
Dementia Awareness
Level 2Mapped to:
Health Education England
Tier 2 Outcomes
Care Certificate Standard
Standard 9 (Dementia)
Common Core Principles
1,2,3,4,5,6,7,8,9
Day One & Day Two
Log in at: http://www.gloucestershire.gov.uk/extra/article/108332/Two-Day-Demen-tia-Training-Programme• Non-GCC staff can register using the “register here” link• GCC staff can register by inputting their SAP user ID in the Username box and then clicking “Request Password” • After you have logged in, click on “Development Options” • Find the course by clicking on “Adult Social Care” or searching for Dementia • Select the button in the “info” column next to the course ( this looks like a page)• Using the drop down box, select the date that you would like to attend and click on “Book Course” • Type in any special requirements, if relevant, and click on “Request Course” • Your manager will then be sent details to approve your booking. You will get a confirmation of the booking when it has been approved, and will be sent details of the course 3 weeks before it
If you experience any difficulty using the on line booking system please contact:01452 324306
Level 2Mapped to:
Health Education England
Tier 3 Outcomes
Care Certificate Standard
Standard 9 (Dementia)
Common Core Principles
1,2,3,4,5,6,7,8,9
DLW Award: QCF level 3Award in Awareness ofDementia
Dementia LinkWorker Award
How to book:
For an application formE-mail Sue Keane at:[email protected]
Dementia Lead Award
How to book:
Contact: Amanda Rawlins
Train the Trainer
How to book:
For an application formE-mail Sue Keane at:[email protected]
CPD SUPPORT FORUMSHeld across the County to enable Dementia Link Workers, Community
Dementia Links those who have successfully completed the Train the Trainer course to build on their knowledge base, share good practice and develop
support networks. Contact: [email protected]
The Dementia Training & Education Strategy for Gloucestershire
Dementia AwarenessE-Learning: Kwango: www.kwango.com
Course Length – 1 ½ Hours
E-Learning: SCIE: www.scie
Course Length – 20 mins x 7 Modules
Community Dementia Link (CDL) – Course Length 2-3 daysThis bespoke programme is designed to meet the needs of community groups with an interest in dementia. Courses range from 2-3 days depending upon requirement. Example groups include village agents.
Gloucestershire Dementia Leadership Award). Dementia Link Worker Award (DLW) Course Length 9 workshops over 9 months
Incorporating the accredited City & Guilds level 3 Award in Dementia Awareness. The Dementia Link Worker Award is completed over 9 whole day workshops over 9 months. This is an opportunity to undertake an in-depth study of dementia and to become a dementia champion for your organisation, embedding dementia theory to practice . This course is fully funded by the Gloucestershire Dementia Training Strategy.
Can only be accessed by environments where a Dementia Lead can offer support (The Dementia Lead must have completed the the Gloucestershire Dementia Leadership Award).
Gloucestershire Dementia Leadership Award).
Gloucestershire Dementia Leadership Award). Dementia Leadership Award (DLA) Course Length 5 workshops over 5 months
The course is open to anyone in a position of authority within their organisation such as clinical leads, managers, commissioners etc. The programme is designed to offer opportunities to consider a range of theories relating to leadership. The course runs 3 times a year, 5 full day workshops over 5 months. It is required that an organisation has a Dementia Lead in place prior to other members of the organisation accessing the Dementia Link Worker programme.
There is a cost incurred for resources, currently £200.00
Train the TrainerWorkshopCourse Length 1 Day with follow up Mentoring in Practice
Designed for people who provide training within their organisation and who would like to develop their confidence in delivering dementia awareness training. Participants are provided with training resources and the workshop is followed by an observation of the participant’s delivery of Understanding Dementia in their workplace.
Description Boxes for Progression Routes
http://www.gloucestershire.gov.uk/extra/dementiatraining
Day 1 & 2 – Dementia Training Course Length 2 days A comprehensive two day course available across Gloucestershire to those with an interest in dementia. Predominantly aimed at Health and Social Care staff although open to others.
The course covers a variety of subject areas including:
What is dementia, memory, the role of the brain, development of skills and approaches to support people, including in times of emotional distress, person centred care, the enriched model of dementia, and the ‘Gloucestershire 5 step Approach to Behaviours that Challenge’.
The above course is a pre requisite for the Dementia Leadership Award and the Dementia Link Worker Award.
The Dementia Training & Education Strategy for Gloucestershire
Prescription for Practice: Glos ‘5 Step Approach’
Background: The effectiveness of non- pharmacological interventions for people with dementia are comprehensively evidenced in the body of literature which pertains to dementia (Howard et al. 2001). This evidence has informed practice guidance (NICE, 2006) and policy initiatives (Prime Ministers Challenge, 2020).
NICE Clinical Guidance 42 states that people with dementia who develop behaviour that challenges should be offered an assessment at an early opportunity to establish likely factors that may generate, aggravate or improve such behaviour.Gloucestershire has developed the ‘5 Step Approach’ – a process & resource pack to support practice which promotes person centred care planning using a red/amber/green (RAG) tool. This approach aims to reduce referrals for specialist input and the numbers of incidents of violence and aggression reported in care homes.
The approach encourages care workers to always consider that the behaviour changes are often a response to emotional stress or emotional triggers, and that the person with dementia is attempting, through their behaviour, to communicate unmet needs, either physical or psychological.
Service Evaluation Methodology:(using a PDSA cycle)
Care home recruited and a baseline of: violence / aggressive incidents specialist referrals recorded
Training (5 Step process) delivered to staff group over 4 x 2hr sessions
5 Step resources made available to staff Follow up visits to the care home x 2 (qualitative feedback received / collated)
6 months post training/implementation of 5 step approach:
Numbers of incidents reviewed Numbers of referrals reviewed
Model of Practice Improvement:
Using the model of improvement the primary
aim was identified as:
‘In Gloucestershire people with dementia likely to experience
behaviours that challenge will be supported by a person centred
approach’.A driver diagram facilitated an opportunity to identify the primary outcome as above, and
the associated activities, factors and measures required to drive the project forward and
evidence whether it achieved the identified outcomes.
Measures Factors Activities outcomes data evidence numbers of
incidents numbers of
referrals
design identify costs develop and
test promotion marketing
research workshops resource
development produce
prototype engagement
PDSAcycleACT DO
PLAN
STUDY
Identity
Inclusion Occupation
Atta
chm
ent
Comfort
Person Centred
Care
Step 1 Gather Information using the checklist (or equivalent life history info) & ABC charts
Step 2Exploring and sharing
information in collaborationIdentify patterns and
meanings for the person
Step 3Develop the
personalised care plan (RAG) plan
Step 4Communicate the
RAG plan to everyone involved in supporting
the person
Step 5Review RAG using information
from further ABC charts
Results & Conclusions:• The reported incidents of violence and aggression in the care home reduced from 8
during the six months prior to the introduction of the resources to 4 in the six months following. (These incidents are reported as alerts to the County Council safeguarding team)
• The number of referrals to 2gether Care Home Support Team (which provides specialist input for behaviours that challenge) reduced from 6 during the six months prior to the introduction of the resources to nil in the six month period following.
• The care home had increased confidence in completing the RAG plans evidenced by 4 residents having completed RAGs with personalised detail.
Green Behaviours Possible Reasons Why? How to Respond?
John likes to spend time:In the garden / outside the home enjoying the fresh air (enjoys countryside and walking)Listening to classical musicSitting in quiet areasEnjoying a hot cup of coffee (not tea)DO NOT RUSH JOHN (as this has the potential to escalate his distress and disorientate him)
John feels:• Safe• Comforted• Engaged & activeJohn enjoys the fresh air and responds positively to having the opportunity to be outside once a day as this fits with his lifelong pattern.
Engage with music in a quiet area where possible:John enjoys orchestral music/classical (CDs available in his room)Encourage family (wife Joan,) to have meals together. John enjoys fish and chips/spicy foods.Walk outside with John after main meal in the evening.
Amber Behaviours Possible Reasons Why? How to Respond?
John starts to walk around in an agitated way usually after supper. He starts to approach other people looking for Joan and reassurance. He may hold onto clothes of staff and residents; as he does so John becomes less able to focus on directions and presents as anxious. John’s strong attachment figure is his wife Joan (married 52 years) so when he is distressed/requiring comfort he searches for her.
Increasing distress highlighted by:• Agitated walking• Holding onto others
Feeling lost / upset /stressed by the environment NB:Past coping strategy when stressed (worked in the armed forces) was to spend time alone, often being outside.
One person to give directions to John. Encourage John away from main lounge area after meals /during busy periods to allow sense of space. Approach John from the front: Say ‘come and walk with me’ Re-direct John to a quiet area /garden area if weather allows.Try diversion/distraction (he likes coffee with 1 sugar) in a quiet area.
Red Behaviours Possible Reasons Why? How to Respond?
John presents as anxious and agitated with a tense expression.He tries to approach others in a forceful way looking for Joan, shaking their clothes.Walks faster holding onto anything in the environment to maintain balance
Feeling very distressed and threatened. Unable to understand why Joan is not around. Looking for reassurance. Not knowing where he is. John’s ability to manage strong emotions is limited.
Think Space:Give John as much space as possible. Keep voice low and slow using short sentences such as ‘you are missing Joan‘ , ’walk with me’If anxiety /distress do not reduce, consider administration of PRN (as needed) medication as prescribed
Example: RAG (Red/Amber/Green) Plan for John:
Verbal feedback from deputy care home manager:
‘I relayed the information to her & she ran with it’
‘They are using them and think
they are brilliant’
References: National Institute for Clinical Excellence (2006) Clinical Guidance 42 Dementia: Supporting people with dementia and their carers in health and social care.Prime Minister’s challenge on dementia 2020 (2015). Available at: https://www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020
Howard, R., Ballard, C., O’Brien, J., et al. (2001) Guidelines for the management of agitation in dementia. International Journal of Geriatric Psychiatry, 16, 714–717.Kitwood Tom (1997) Dementia Reconsidered: The Person Comes First (Rethinking Ageing)
May Hazel; Edwards Paul; Brooker Dawn (2009) Enriched Care Planning for people with dementia. Bradford Dementia GroupSiriwardena, A Niroshan; Gillam, Steve (2013) Understanding processes and how to improve them. Quality in primary care 2013, Vol.21(3), pp.179-85
For further information about the Gloucestershire 5 step approach go to www.gloucestershire.gov.uk/extra/dementiatraining OR contact [email protected] (if adopting this approach
we would expect the ‘Gloucestershire Training & Education Strategy’ to be referenced)
