Older patients spared dementia and falls by NHS tech roll-out

Digital checks that can prevent dementia and falls in older people are among a range of tools being made available in hospitals across the country, as part of the NHS Long Term Plan | Via NHS England

night-933094_1920

One in eight hospital patients is affected by delirium, which can make people unsteady on their feet, increases the risk of developing dementia and can result in longer hospital stays or admission to a care home.

However, these problems can be avoided through timely and effective care, with a scheme in Salford increasing the number of patients correctly diagnosed with delirium by 34%, through the introduction of screening for all over-65s who are admitted to hospital. Doctors and nurses run through a symptoms checklist on a mobile computer or handheld device.

The new electronic assessment tool for delirium has increased screening of over 65-year-olds on admission to hospital and has increased assessment of those who become newly confused when they are in hospital, with the number of identified cases per year having risen by 34% and the length of stay for these patients has reduced by 11%, saving an estimated £1.7m in the first year. Readmissions for delirium patients has also reduced from 15% to 13% saving an estimated £101,000 for the same period.

The scheme is just one of a series that is being rolled out across the country through the adoption of toolkits, known as blueprints, that allow any NHS hospital to implement improvements quicker and more easily to transform care and improve services for patients and staff.

Full detail at NHS England

Assessment of delirium in hospital for people with dementia

This report published by the Royal College of Psychiatrists provides a full breakdown of results from a national audit focusing on the identification and assessment of delirium in general hospitals.  It also includes key findings, recommendations, and a discussion of results. 

Key findings

spotlight
Image source: http://www.rcpsych.ac.uk/

A high proportion of patients with dementia admitted as emergencies to hospital did not receive an initial assessment for delirium, even after adjustment

After taking account of the greater number of initial assessments identified by the additional questions included in the questionnaire, we found that 32% of patients with dementia, admitted to hospital as an emergency, did not have an initial assessment or screen for delirium. At just under one third of the sample, this remains a very high proportion of people at high risk of delirium and requires improvement.

Questions about initial screen or assessment for delirium are inconsistently interpreted

Variation is apparent in the approach hospitals take to carrying out and recording the assessment of delirium, as questions about an initial screen or assessment for delirium are inconsistently interpreted. In 219 (10%) casenotes, auditors reported no screen, but questions about specific assessments found that it had taken place.  Following adjustment allowing for responses for the follow up questions, results for individual hospitals improved by an average of 19% with individual hospitals seeing increases ranging from to 64 percentage points.

Over a quarter of patients have no confusion or cognitive tests recorded

37% of patients received no confusion or cognitive tests at all, as well as no initial screen.  Cognitive assessment is an important part of comprehensive assessment which all patients with dementia admitted acutely should receive.

Delirium not included in discharge correspondence

Only 48% of patients whose casenotes recorded possible delirium at admission or after initial screening had this recorded on their discharge letter or summary.  All patients who have delirium during admission to hospital should have this information communicated to their General Practitioner (and Primary Care team) on discharge.

Full report: Assessment of delirium in hospital for people with dementia. Spotlight audit 2017 – 2018

 

Dementia Assessment and Referral

Information on the Dementia Assessment and Referral data collection for the period April 2017 to March 2018 | NHS England

This data collection reports on the number and proportion of patients aged 75 and over admitted as an emergency for more than 72 hours in England who have been identified as potentially having dementia, who are appropriately assessed and who are referred on to specialist services.

March 2018 Data (Quarter 4 2017-18) (released 6th June 2018)

Care for older people with frailty in hospitals

A frailty checklist was completed in only a quarter of older people at hospital admission | National Institute for Health Research (NIHR)

Frailsafe is a simple safety checklist offering the opportunity to improve safety and quality of care for frail older people while in hospital. It aims to increase key clinical assessments or practices on things like risk of falls, mobility and delirium, and to facilitate communication between staff.

Frailsafe was introduced in 12 NHS hospitals to help health professionals complete key frailty assessments and ultimately improve patient outcomes. This mixed methods study aimed to evaluate how local teams had implemented Frailsafe across the 12 participating NHS trusts and what they thought about it and its influence on patient safety and quality of care.

The study found that compliance with the items on the checklist for the whole period across the 12 sites was 24% (1,687 completed 7,201 checklists). This means only about 1 in 4 patients had evidence if receiving all the appropriate checks. Most hospitals completed the medication reviews and pressure ulcer risk assessments (around 60 to 100%). There was wide variation in the completion of delirium and dementia assessments (between 3 and 96%).

Full reference: Papoutsi C, Poots A, Clements J, et al. |  Improving patient safety for older people in acute admissions: implementation of the Frailsafe checklist in 12 hospitals across the UK | Age and Ageing | 2018

Related: National Institute for Health Research: A frailty checklist was completed in only a quarter of older people at hospital admission

Dementia assessment and improvement framework

An evidence-based framework to support and enable directors of nursing and medical directors to achieve ‘outstanding’ care standards for those living with dementia during their stay in hospital | NHS Improvement

This framework has eight standards, and draws on learning from organisations that have achieved an ‘outstanding’ rating from the Care Quality Commission. The document integrates policy guidance and best practice with opinion from patients and carers.

General practitioners’ practices when suspecting cognitive impairment

General practitioners (GPs) play a major role in the assessment of dementia but it is still unrecognized in primary care and its management is heterogeneous | Aging & Mental Health

medical-563427_960_720

Objective: Our objective is to describe the usual practices, and their determinants, of French GPs in this field.

Results: Hundred two GPs completed the study. GPs were in majority men, working in urban areas. Mean age was 54.4 years old. GPs’ feeling of confidence and self-perception of follow-up of national recommendations is linked with their practices. Performing a clinical interview to assess cognitive impairment is linked with good communication skills. GPs feel less confident to give information about resources for dementia. The main reason alleged for underdiagnosis is the limited effectiveness of drug therapy.

Conclusions: This study underlines the importance of GPs’ feeling of confidence when managing cognitively impaired patients with dementia, and the need of increasing training in the field of dementia, which could improve the awareness of GPs about diagnosis and available resources.

Full reference: Harmand, M.G-C. et al. (2017) Description of general practitioners’ practices when suspecting cognitive impairment. Recourse to care in dementia (Recaredem) study. Aging & Mental Health. Published online: 8 June 2017

Psychological Dimensions of Dementia: Putting the Person at the Centre of Care

The following report, put together by the British Psychological Society Dementia Advisory Group, presents a psychological perspective on the nature and experience of dementia

dementia-bps
Image source: BPS 

As well as outlining the roles and contributions of psychologists in the field of dementia care (particularly in supporting a move towards addressing dementia not only in terms of the underlying disease but also in considering the practical dimensions of social and cognitive disability associated with it), this report presents recommendations for action in the following areas:

  • Prevention
  • Assessment
  • Planning of care
  • Treatment and support
  • Dealing efectively and appropriately with families and carers
  • Training and research

These recommendations were produced in consultation with people experiencing dementia, their families, and their carers, in order to present a truly person-centred approach to dementia treatment and management in the UK.

Read the overview here

Read the full report here