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Paulene Mackell, Department of Health, Victoria: Implementing "Best Care For Older People Everywhere: The Toolkit' to improve care for older popel with cognitive impairment in Victorian health services

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Information about Paulene Mackell, Department of Health, Victoria: Implementing "Best Care...
Health & Medicine

Published on February 20, 2014

Author: informaoz

Source: slideshare.net

Description

Paulene Mackell, Senior Project Officer Ageing and Complex Care, Department of Health, Victoria delivered this presentation at the 2014 National Dementia Congress. The event examined dementia case studies and the latest innovations from across the whole dementia pathway, from diagnosis to end of life, focusing on the theme of "Making Dementia Care Transformation Happen Today. For more information on the annual event, please visit the conference website: http://www.healthcareconferences.com.au/dementiacongress2014
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– 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 Number of 70+ year hospital separations to total 2012-13. • 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 Red line indicates predicted population growth for 70+ years 1,000,000 900,000 800,000 700,000 600,000 500,000 400,000 300,000 200,000 100,000 0 Total seps 2012- 70+ seps2012-13 13 2021/22 2031/32

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/patientexperience.htm

Evidence Based Improvements 1. Environmental improvements 2. Organisation-wide policy development 3. Models of care 4. Capacity building

An example: Western Health 23 inpatient clinical areas 6170 staff Evidence : The Toolkit 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

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