paulene mackell, department of health, victoria: implementing "best care for older people...

Implementing the Best care for older people

everywhere: The toolkit

Paulene Mackell Department of Health & The National Ageing Research Institute

–

Improving care for older people in hospital

Improving Care for Older People policy (2003)

COAG LSOP initiative

Improve the capacity of health services to provide more

appropriate care for older people by minimising functional

decline.

Supported by: two key resources

Best care for everyone everywhere: The toolkit

The environmental audit tool

Why develop these resources?

Increasing demand particularly frail older people with chronic & complex conditions

Increasing prevalence of dementia

The rate of fatal adverse events associated with hospitalisation is 10 times higher for people aged over 65 than for those younger than 45

)

Functional decline

• is a reduced ability to perform activities of daily living due to a

decrease in physical or cognitive functioning.

• Approx 34-50% of older patients experience functional decline

in hospitals.

• can occur as early as day two of hospitalisation

• 30% of hospitalised older people, functional decline is

unrelated to their primary diagnosis.

• At 3 months following discharge only 50% of older people

recover from functional decline

Older people in our hospitals

• 42% of adult multiday

separations from hospital are

by patients over the age of 70.

• This accounts for 50% of the

total adult multiday hospital bed

days

• Hospital stays for patients over

85 years account for 17% of

these numbers

• Currently +85 year olds make

up around 2% of the Victorian

population

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

Total seps 2012-13

70+ seps2012-13 2021/22 2031/32

Number of 70+ year hospital separations to total 2012-13. Red line indicates predicted population growth for 70+ years

We also know

• 20% of people in hospital aged over 70 have dementia

• Cognitive impairment is often under recognised in

Australian hospitals

• 10 -22 % of older people have delirium at admission &

a further 2-25% will develop it during their stay.*

• People with cognitive impairment usually present to

hospital for another primary reason.

Contributors to functional decline

• Under-nutrition & dehydration

• Decreased mobility and loss of independence

• Pressure injuries

• Incontinence

• Falls

• Delirium

• Medication errors

• Depression

Prevention

• For patients with cognitive impairment, many of the poor safety

and quality outcomes are preventable

• Earlier & accurate identification

• Comprehensive assessment – involving families

• Modify the environment & implement risk reduction strategies

• http://www.health.vic.gov.au/older/patient-

experience.htm

Evidence Based Improvements

1. Environmental improvements

2. Organisation-wide policy development

3. Models of care

4. Capacity building

An example: Western Health

Evidence : The Toolkit

23 inpatient clinical areas

6170 staff

What are the opportunities to support

workforce

Workforce

• Non-clinical support staff (22%)

• 450 Volunteers

Why was this group the focus of the project?

direct patient, carer and family contact

tended to work in one clinical area: not rotating

had gaps in education

Understanding Dementia Program

• Developed and funded through a dementia fellowship

program.

• Focus on non-clinical (22% workforce)*

• First of its kind in Victoria

• The aim

provide education on how to communicate with

patients with cognitive impairment

to develop a volunteer program to support

patients with dementia in hospital.

Outcomes

• By undertaking these two approaches WH have been

successful in using the Toolkit to:

– Empower and educate staff to improve practice

– Draw on existing staff resources & value their roles

in contributing to improving care

Keeping The toolkit Current

• DH is collaborating with The National Ageing Research

Institute & Victorian health services to review currency

of content & develop e-learning package

• Accessibility

• Toolkit can be accessed: www.health.vic.gov.au/older

• Video material: Patient experience

Sustainability & The toolkit

• Australian Commission on Safety & Quality in Health

Care :

• Mapping between the toolkit and NSQHSS shows

many direct or similar links:

Standard 8

Preventing and

Managing Pressure

Injuries

Sustainability & The toolkit

• Clinical Leadership Group on care of older people in

hospital

• Building a legacy of the Initiative: Share expertise,

knowledge & experience

• RMH EpiCentre are at the initial stage of exploring a

large dementia care pathways project

• The 35 participating health services have built

sustainability into their governance structures and

policy and practice levels