Transcript Maureen Strudwick and Tony Phiskie

TOP 5 – Engaging CALD carers
to personalise hospital care for
people with cognitive impairment
Maureen Strudwick & Tony Phiskie
Carer Support Units
CCLHN & SWSLHN
March 2011
TOP 5
 What 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 Evaluation
Staff 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