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Patient Centered Care for

Those who also have

Dementia

CCME CNE Course Announcement

Activity Title: Patient Centered Care for Those Who Also Have Dementia

The Carolinas Center for Medical Excellence (CCME) is accredited as an approved provider of

continuing nursing education by North Carolina Nurses Association, an accredited approver of

continuing nursing education by the American Nurses Credentialing Center's Commission

on Accreditation.

This activity has been awarded 1.0 contact hours of Continuing Nursing Education (CNE) credit

CCME utilizes industry accepted mechanisms to identify and resolve conflicts of interest. The

planners, faculty, and speakers for this activity have no unresolved relevant financial relationships

with commercial interests that could be perceived as a conflict of interest

CCME has received no commercial support related to this educational activity

In order to obtain credit, you must register, attend webinar, complete survey evaluation questions

before you leave the webinar and complete attendance attestation through SurveyMonkey tool by

April 28, 2014, the expiration date for awarding contact hours. We will then provide you with an

attendance certificate for your records.

Patient Centered Care

for those who also have Dementia

A story of possibility!

How big an issue is this?

Source: https://www.alz.org/alzheimers_disease_facts_and_figures.asp#quickFacts

Catalyst for Change

Her mantra: “What can I do

to help?”

Mary Anne

Because of Mary Anne

Picture of

Cheryl

Eleanor (Ellie) McConnell, PhD, RN, GCNS-BC Director of Grand Challenge in Dementia Initiative

John Barrett Mary Anne’s Husband

Cheryl Batchelor, MSN, ANP-BC, NEA-BC, FACHE, Adult Nurse Practitioner

“A difficult and frustrating journey”

• 2005 – Mary Anne diagnosed at age 54

• 2010 – Dementia advanced with significant symptoms beyond memory loss

• August 2010 from care at home to memory care facility – then another

– asked to leave each

• Finally admitted to state psychiatric hospital

The Journey Continues

• 2010 - 5 Hospital interactions within 6 months • Each could have gone better

• John and Geriatric Care Manager collaborated to write Mary Anne’s story

• Catalyst to improve care for patients with dementia

• Shared with Chief Nursing Office at local hospital

Chief Nursing Officer’s Perspective

• Aging Demographics

• System-wide Approach to Special Care Need

• Staff Competency / Education Needs

• Patient/Family Advisory Council (PFAC)

• Self Assessment / “Ground Zero”

The Challenge

Patient and Family Perspective

• Patients with dementia can’t speak for themselves

• Many staff, while good at their tasks, seemed oblivious of special needs

• Would the hospital see the necessity for making changes

• Would the hospital be open to input from “outsiders”

Hospital Perspective

• Care processes

– Do we ask the right questions?

– Do we organize care in the right manner?

• Staff capability

– Do they have the right knowledge?

– Do they have the right information about the person?

– Do they have the right skills?

– Which staff are most involved?

Response: Task Force with Diverse Perspectives and Talents Chartered

Composition • Interim Chief Nursing Officer • PFAC Member • Community Members • Physician champion • Nursing Staff Representation • Registration Staff • Case Management • Professional Development /

Staff Development

Scope

• Inpatient / ED Care

• Not addressed by TF – Behavioral Services

– Discharge Planning

– Food Services

– Home Care Services

Framework for Patient-Centered Dementia Care

Core Element How achieved

Increased awareness of special needs of patients with dementia

Staff education: All professions, all levels; Community education

Improved identification of those with dementia

Changes in hospital procedure (Grey Wristband)

Targeted assessment on admission to support PCC

Changes in nursing assessment elements and admissions database

New expectations about how care is given

Hands-on skills training using experts from AlzNC using a “train-the-trainers” approach

Evaluation Accredited CE evaluation data & Other sources

Shared understanding of what a dementia-friendly environment means

Ongoing CE and program development for all levels of staff, including booster sessions

Dementia care protocol Five components including Environmental Suggestions, Care Approaches, Communications

Roadmap

Leadership: Task Force

- Form Task Force

- Review Evidence & Best Practices

- Establish bench- marks & monitor progress

Education: Staff & Family

Nursing: - Train-the-trainer expectations & skills

Family: - Preparing for hospitalization: brochures & seminar

Medicine: - Annual symposium included sessions on dementia

Protocol: Develop, Implement, Sustain

- Admission assessment changed -Grey wrist-band for AMS implemented

- Protocol piloted & Spread hospital-wide

Task Force Timeline: April 2012 through May 2013

Discoveries & Insights

Family Caregiver Perspective

• New approaches are feasible, and truly make a difference

• Opportunity via PFAC membership to spread elsewhere within the health system (e.g., home care services, food services)

Health System Perspective • We weren’t asking the right

questions on admission to the hospital

• We could reliably identify people with cognitive dysfunction, helping the staff recognize need for “special handling”

• Staff have “ah-ha!” moments and want to change/improve care and approaches

• Need to embed in annual training to promote sustainability

Next steps

Family Caregiving Perspectives

• Identifying the special discharge needs of the patient and caregiver (both ED and In-patient)

Health System Perspective

• Nursing participation in the Duke Grand Challenge in Dementia

• Creating a multidisciplinary home health pathways of care for patients with dementia

Keys to success…

• Systems approach: – Integrating education and practice change with

administrative support

– Involving multiple professions, multiple units in organization

– Experienced consumer involvement

• Task force with eye toward sustainability: – Integration with work of patient/family advisory council

– Use of train-the–trainers approach

– Systematic spread to other parts of the organization (home care)

Challenges Remain

Family Caregiver Perspective

• Timely gero-psych access – Evaluation

– Care

• Protocol for assessment and referral

Hospital System Perspective

• Education and training in handling special situations

• Sustainability

“FirstHealth changes protocols and introduces training towards becoming

dementia friendly” The Pilot, December 12, 2013

Questions & Discussion

Biographies

• Eleanor (Ellie) McConnell, PhD, RN, GCNS-BC • Associate Professor, Duke University School of Nursing

• Director, Hartford Center of Excellence in Geriatric Nursing Excellence

• Clinical Nurse Researcher, Durham Veterans Affairs Medical Center Geriatrics Research, Education and Clinical Center (GRECC)

• Career-long interest and experience in Dementia Care

• Director of Grand Challenge in Dementia Initiative –http://cgne.nursing.duke.edu/

• Contact: eleanor.mcconnell@duke.edu, 919-684-9229

Biographies

Cheryl Batchelor, MSN, ANP-BC, NEA-BC, FACHE

Adult Nurse Practitioner, FirstHealth Transition Care Clinic

Interim Chief Nursing Officer, FirstHealth Moore Regional Hospital, 2011 -2013

Contact Information: cbatchelor@firsthealth.org

910-715-3097

Biographies

• John Barrett, Family Advocate • Wife Mary Anne diagnosed with Alzheimer’s in 2005, now in

late stages of disease

• Her mantra “what can I do to help”

• Caregiver support group assistant and participant

• FirstHealth Patient Family Advisory Council Charter Member

• MooreHealth Inc. Aging Issues Committee Member

• Contact: Johnfb68@gmail.com, 910-447-9613