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Think Delirium Scottish Delirium Association Pathway Overview & Sharing Good Practice Linda Wolff Mike Hendrix, NHS Forth Valley
Improving detection and Management of delirium in hip fractureExperience in Forth valley orthopoedic unit Linda Wolff Mike Hendrix
Outline Where are we now? Where do we want to be?How are we trying to get there?
Why Bother? National PriorityDelirium present in up to 60% patients over 65 with hip fracture 3rd busiest ortho unit in Scotland 380 hip fracture patients/ year Pressure on beds Staffing challenges
Delirium Outcomes Delirium present in up to 60% patientsLength of stay x 3 40% mortality High morbidity Stress
Patients and carers say…Said he was being difficult Said she has dementia They didn’t explain Took her food away Too much medication I was so worried
Where do we want to be? Reliable recognition and management of delirium in patients with hip fracture
How are we trying to get there?Steering group Questionnaires- staff Patient stories Identification of delirium Develop management protocol
Protocol AMT 10 CAM Medical Pain Management Nursing Discharge
Tests of change
Training All nursing staff Hospital Delirium Study DaysPresentations to ortho surgeons
AMT 10 Who will do it ? Junior docs, staff nurse, ANPs AuditFlow chart Screen saver
Untreated delirium can increase length of stay up to 3 times
Any one of these can cause delirium:Infection Fracture Pain Mental stress Constipation Dehydration Low oxygen levels Morphine
How are we doing?
Delirium Bundle CAM Done 1L fluid in first 24 hours Abbey pain scoreDi-hydrocodeine prescribed Up to sit within 24 hours Delirium documented Discharge letter All or nothing
Bundle data July 2012 50 % had AMT, 83% <9/10 30% had CAM 60% fluid >1L No Abbey Pain scores 100% analgesia compliance 60% up to sit in 24 hours NO documentation in letter
Sprint Audit 2013 - 24 pts 66% AMT10 62% of those had AMT <9 9/10 had a CAM performed 33% of those CAM +ve AWI challenges
Successes Improved cognitive assessment Improved staff knowledgeMore consistent pain management Increased documentation of delirium Introduction of butterfly scheme Carer’s letter to CE Mike feel free to add…
Challenges Cognitive assessment / detectionDelirium Bundle just starting AWI irregularities Engage all medical staff Evaluation LOS, complaints, questionnaires, discharge documentation
Introduction to ‘Immediate management of delirium care bundle’ and change package Karen Goudie, Clinical Advisor a Michelle Miller, Improvement Advisor.
Jane Balmer & Kirsty McNeil University of Dundee College of Medicine, Nursing & Dentistry Recognising Delirium in an Acute Medical Setting Results Introduction.
Older People in Acute Care Identification of need and Care Planning Dr Cesar Rodriguez, NHS Tayside Dr Sridhar Valtheswaran, NHS Grampian Clinical Leads,
Setting up the “Beacon wards” Colin MacDonald Alzheimer Scotland Nurse Consultant NHS Lothian
Counting the cost Caring for people with dementia on hospital wards.
Improving Care for Older People in Acute Care Penny Bond Implementation and Improvement Team Leader Healthcare Improvement Scotland.
The Attitudes of Elderly Patients and their Relatives to being Boarded from Acute Medical Assessment at the Edinburgh Royal Infirmary. Amy Begg Staff.
Cornwall Hydration Project
Safe discharge from hospital?
Care Experience Breakout Sessions Trudi Marshall
Supporting people with dementia who also have complex physical health conditions Patricia Howie Educational Projects Manager.
Improving general hospital care for people with dementia: why, how and with whom? Nye Harries DH SW.
Alzheimer’s & Dementia S U P P O R T S E R V I C E S Sarah Parsons Senior Nurse Service Modernisation, Adult Medicine, Darent Valley Hospital.
The Orthopaedic view point Care shared with orthogeriatrician Peri-operative checklist Ask the each bedside Little time needed on average.
NUH Clinical Strategy 2010 Dementia. 1 The story In February 2009 the National Dementia Strategy was launched. It is a five year plan to transform the.
Running To Catch Up Transforming Dementia Care in UK hospitals RUNNING TO UP CATCH UP TRANSFORMING DEMENTIA.
Developing a commitment to the care of people with dementia in general hospitals Outcomes of RCN project Making Sense: working in partnership to improve.
We’re counting the benefits of EPR Find out at: epr.this.nhs.uk We’re counting the benefits of EPR Find out at: epr.this.nhs.uk The introduction of EPR.
University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences Psychiatric illness in older people in general hospitals John Holmes Senior Lecturer.
Respiratory Care Bundles Professor Thida Win Lister Hospital
Dementia Ward Charter Mark Dr Chris Dyer, Consultant Geriatrician Clinical Lead Older People’s Services RUH.
Working together to improve the patient experience Allyson Kent – A2A Chair
Patient/Relatives comment s Fantastic people, I knew what was happening to me and lots of attention (interview in A&E) 10 out of 10, first class service.
SNAP Scottish National Audit Project CE Bucknall Chair, Bicollegiate Physicians Quality of Care Committee, on behalf of project team.
CHOPS Care of the Confused Hospitalised Older Persons Study.
“Measuring the Units” Alcohol liaison services (ALS) Louise Poley Consultant Nurse in Substance Misuse Cardiff and Vale University Health Board.
Elderly Frailty Project in Teesside
Embedding EPiC in Practice NHS Greater Glasgow and Clyde Acute Division.
How we collect data for SATs, SBTs, RASS and SAS How has data collection affected our work flow Have we made any improvements in patient care?
Implementing the National Safety and Quality Health Service Standards Margaret Banks Program Director June 2, 2015 What is, and what is to come.
Stroke Services at HWPH NHS Foundation Trust
General hospital care for people with dementia: mechanisms to effect change Nye Harries DH SW.
JCAHO EXPECTATIONS FOR PRIMARY STROKE CENTER
A New Approach To Nursing Home Liaison: Lochaber Telemedicine Clinic NHS Highland Dr Fiona McGibbon Consultant Old Age Psychiatry.
Developing a Trust wide framework to support Nurse Facilitated Discharge to reduce length of stay Kate Pound and Sue Haines Service Redesign Manager Assistant.
Making general hospitals fit for dementia care 27 th International Conference of Alzheimer’s Disease International London 2012 Rachel Thompson RCN Dementia.
Improving handover in the ED setting “SBAR“. Objectives of the “SBAR Squad from A&E” Where we are Where we need to be What do our staff think How far.
National Audit of Dementia – care in general hospitals National Audit of Dementia Royal College of Psychiatrists Centre for Quality Improvement 4 th Floor.
MSK & Orthopaedic Quality Drive Programme
Delirium in the acute hospital
ABHB Interventions aimed at reducing - CAUTI
Hospital Discharge The Carers Journey Developed On Behalf Of Action For Carers (Surrey) And Surrey County Council.
Narelle Marshall (AARCS Nurse) & Darlene Saladine (Acute Pain Service Nurse) November 2012 ‘A Multidisciplinary Approach to the Prevention of Pressure.
Registered Charity No: Registered Charity No: Nutrition screening: why bother Adapted presentation originally.
Introduction of Frailty Tools and Change Package Brian McGurn NHS Lanarkshire Michelle Miller Healthcare Improvement Scotland.
EFFECTIVE C difficile (over 65) Apr-Jun 14 MRSA bacteraemia Apr-Jun 14 MSSA bacteraemia Apr-Jun 14 For the 2 month period July- August 2014, there were.
Abstract Objectives: Our objective is to improve management of CAP by defining and implementing a bundle of essential elements of care that must be delivered.
National Adult Inpatient Survey 2012 Presentation of survey results May /27/2015.
NCEPOD Report – an age old problem Nov 2010 Reflections and how we can do better Finbarr Martin Geriatrician, Guys and St Thomas’ Hospitals and President,
Baseline Assessments Hospital: Pressure ulcer Incidence 8-13% Pilot Ward (Anglesey): Baseline incidence rate - 4.5% Nutritional assessment - 50% Pressure.
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