Maureen Strudwick & Tony Phiskie Carer Support Units CCLHN & SWSLHN March 2011 - PowerPoint PPT Presentation

TOP 5 – Engaging CALD carers to personalise hospital care for people with cognitive impairment
1 / 35

  • Uploaded on
  • Presentation posted in: General

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. TOP. 5. What is TOP 5?. A process to

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation

Maureen Strudwick & Tony Phiskie Carer Support Units CCLHN & SWSLHN March 2011

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Maureen strudwick tony phiskie carer support units cclhn swslhn march 2011

TOP 5 – Engaging CALD carers to personalise hospital care for people with cognitive impairment

Maureen Strudwick & Tony Phiskie

Carer Support UnitsCCLHN & SWSLHN

March 2011

Top 5


What is TOP 5

Pilot Study





What is top 5

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

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

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

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

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 results1

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

TOP 5 Implementation

  • Gain support

  • Address Issues

  • Communicate Gains



Gain support

Gain support

  • Establish partners:

    • Ward leaders - NUMs, CNCs, CNEs,

    • Delirium & Dementia CNC

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



Address issues

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

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

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

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

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

TOP 5 for CALD Carers

Getting Started in SSWAHS

Lessons Learnt



Interest in top 5 in sswahs

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Instigating top 5 with cald carers con t

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

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

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

…and more lessons … Establishing Worth & Good Will

  • Hospitals

  • Networks – hospital and community networks

  • Working groups

  • LHN Executive

  • Community

    • General Aged Care

    • CALD groups



  • 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:

  • Login