Maureen Strudwick & Tony Phiskie

Carer Support UnitsCCLHN & SWSLHN

March 2011

TOP 5 – Engaging CALD carers to personalise hospital care for

people with cognitive impairment

TOP 5What is TOP 5

Pilot Study

Implementation

Evaluation

What is TOP 5?

A process to

– identify & engage the carer of a patient with cognitive impairment.

– negotiate and record up to five carer “strategies” that promote person-centred care and communication on the ward.

Where is TOP 5 located?

– Strategies are documented and located on the bed chart.

– an I.D. tag is placed on the top of the chart

– a sticker is placed on the spine of the medical record.

TOP 5 is person-centred practice which

Recognises the importance of engaging carers.

Values their knowledge, expertise and tips in caring for their care recipient.

Effectively communicates carer’s information across sectors, people, systems.

Creates a more settled and comfortable environment

Reduces incidents of adverse events

TOP 5 Pilot

4 Acute Care Wards were targetted for 8 week Top 5 pilot

Top 5 Champions were sought and trained

Staff and Carers were surveyed pre and post pilot

Staff were trained in carer role, and carer engagement

Top 5 Pilot Study Results

Staff reported patients to have:

• a quicker recovery

• less agitation, frustration and distress

• more effective communication

• increased ability to relate

Top 5 Pilot Study Results

Carers noted staff to:

• have increased awareness of their role (58% to 90%)

• invite them to share patient information (54% - 89%)

• listen and take on what they shared (54% - 72%)

TOP 5 Implementation

Gain support

Address Issues

Communicate Gains

Gain support

Establish partners:

– Ward leaders - NUMs, CNCs, CNEs,

– Delirium & Dementia CNC

– Ward ‘champion’ for “Carers as Partners in Care”

Address Issues

Resistance to “yet another thing to do”– Create confidence in the process using

“champions” to model the process and to coach their peers,

– Demonstrate value of TOP 5 by using feedback at ‘handover’ and case conferences

– Embed TOP 5 in protocols for ward admissions, falls prevention, and delirium detection.

Communicate Gains

Wins for all parties– Reduced incidence of adverse events

– Reduced length of hospital stay

– Improved safety for patients, and staff

– Improved staff/patient & staff/carer relationships

TOP 5 Evaluation 2010

9 hospital wards in the CCLHN were included in the survey

64 Staff members included 43 nurses, 9 ward nursing executive, 2 medical and 10 allied health staff were interviewed

TOP 5 Evaluation Results

93% of staff were aware of Top 5

91% of staff reported Top 5 strategies benefit the patient

98% of nurses reported Top 5 strategies benefit them in nursing the patient

98% of staff said they would recommend Top 5 to colleagues and other health professionals

TOP 5 EvaluationStaff Comments:

– “Highly recommend it”

– “A great initiative”

– “Makes my job easier”

– “Less pressure, helps with knowing a patient”

– “Easy to use”

– “Very effective”

– “Really good resource tool, promotes patient comfort”

TOP 5 for CALD Carers

Getting Started in SSWAHS

Lessons Learnt

Interest in TOP 5 in SSWAHS

Carer from SSWAHS Community Participation Network had heard Maureen’s presentation at 09 Conference

– Raised as agenda item at CAP committee Sep 09

Resolved to investigated interest in Top 5

– Carers’ Program sent names of “interested parties”

Meeting of “interested parties” called for Oct 09

Carers’ Program, SSWAHS investigate TOP 5

EOIs asked from potential Top 5 sites

More info sought from CSU, NSCCAHS

I attended Dementia Café

Maureen invited to present

TOP 5 promoted on Intranet Bulletin Board (Home Page)

Overwhelming response – 85 rsvps

NUM Quote on interest in TOP 5

“What appeals to me is the simplicity of the initiative and the simplicity of the actual Top 5 page that will go in the patients bed chart . . . . and the absence of the 25 page instruction manual; mandatory one day education; policy requirements; mandatory education about the policy; the mandatory monthly data reporting; and mandatory training on the mandatory monthly reporting data.”

Concerns by Carers Program

No dedicated staff member to oversee project

Is current context appropriate to embed TOP 5

– Budget

– Staff shortages

– Introduction of LHNs

Incorporating CALD Population

Liverpool Aged Care Unit have developed resources for CALD patients and Carers.

CNE of Liverpool ACU attended first planning meeting & Maureen’s seminar and raised issue of Carers Program of CALD carers

Close to 50% of patients in Aged Care Unit from CALD backgrounds

CALD Population in SSWAHS

the most culturally diverse populations in NSW live within the Sydney & SWS LHNs

40% speak LOE at home (26% in NSW)

60% in Fairfield and Canterbury

Greatest no. speaking LOE at home:

– Arabic, Vietnamese, Cantonese, Italian & Greek

CALD Population in Liverpool

SSWAHS Translation and Language Service

Identified 5 major community languages in Liverpool LGA: Arabic, Chinese, Serbian, Spanish, Vietnamese

Translated TOP 5 resources into Community Languages

– The brochure on Top 5

– The pre and post Top 5 evaluation surveys

Establishing commitment

Meeting of interested staff (April 2010) – good response 20 staff representing Balmain, Bankstown, Bowral, Camden, Campbelltown, Liverpool.

Braeside (Fairfield Aged Care), Fairfield Hospital and Concord hospital also expressed interest.

Outlined what the Carers Program could offer in way of support and funding for CALD resources

Developed a process for getting things started.

The process begins ….

Staff went back to their workplaces to garner local support for TOP 5

Essential that Working Groups established at each site

Balmain, Bowral, Braeside, Camden, Liverpool, Fairfield

ISSUE: Lot of interest BUT Carer Program unable to provide backing at the rate of rollout.

Working Groups established….

Carers Program letter to facility administrations

TOP 5 processes established:

– Training of Staff

– Development of Manual

– Starting date

Staff trained at each site

– Balmain – all wards

– Camden – Medical Transit Unit

– Liverpool – aged care wards

CALD Patients and Carers

Clinicians identifying CALD patients and carers receiving ‘less than’ service

– Use of interpreters

– Communication issues

– Requires greater staff effort for same result with patient

– Cultural differences around the role of family and carer

– Religious beliefs, superstitions

– Variations in translation of English

Research Confirms Clinicians Experience

Local and National research has established access barriers for CALD Carers:

– Difficulties with language

– Lack of knowledge of services

– Lack of culturally & linguistically appropriate services & assessment for their carees

Local Focus Group Research Aged Care Research Unit, Liverpool Hospital

Not speaking English was a major issue in communication of information

Need for Dementia education for CALD & broader community

Hospitalisation noted as a factor in the decline in condition of PWD

Comments on Dementia care in Dr’s surgeries, Day Care Centres, Residential Care facilities and Community Services.

Lack of understanding & culturally appropriate care in hospitals

Instigating TOP 5 with CALD Carers

WHO?

– Nursing are 24 hours, 7 days a week

– Nurses have specific high priority protocols that MUST be followed prior to end of each shift

– Nursing has competing demands on time, energy, and mental space

BUT TOP 5 WILL START OR FINISH ON THE WARD

Instigating TOP 5 with CALD Carers con’t

TIME

– Arranging time with carer

– Booking interpreters

– Time-poor Nursing staff looking at longer time to work with CALD carers

– Cultural differences impact on relationship between carers and staff

Feedback Essential

Staff need to know that Top 5 is worth the effort

Limited day-to-day involvement Carers’ Program

Local data collection – CALD Carer specific

Lessons Learnt

Need for a dedicated project worker to support working parties

Engage Geriatricians

Working Parties need to be endorsed formally by executive

Definite commitment by nursing administration

Working Parties staff training must include engaging and communicating with CALD carers

Involvement of “community”

…and more lessons … Establishing Worth & Good Will

Hospitals

Networks – hospital and community networks

Working groups

LHN Executive

Community

– General Aged Care

– CALD groups

REFERENCES

NSWHealth “Carer Action Plan 2007 – 2012”

Alzheimer’s Australia Victoria “Perceptions of Dementia in Ethnic Communities “ October 2008.

NSWHealth “Easy Guide to Clinical Practice Improvement” 2002

Foreman, P & Gardner, I. (2005). Evaluation of Education and training of staff in dementia care and management in acute settings. Melbourne: Victorian Department of Human Services

Web references:

www.health.vic.gov.au/agedcare/

www.nsccahs.health.nsw.gov.au/carersupport/cc/centralcoast.shtml