1 / 35

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 Units CCLHN & SWSLHN March 2011. TOP 5. What is TOP 5 Pilot Study Implementation Evaluation. TOP. 5. What is TOP 5?. A process to

esben
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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. TOP 5 – Engaging CALD carers to personalise hospital care for people with cognitive impairment Maureen Strudwick & Tony Phiskie Carer Support UnitsCCLHN & SWSLHN March 2011

  2. TOP 5 What is TOP 5 Pilot Study Implementation Evaluation TOP 5

  3. 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. TOP 5

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. TOP 5 Implementation • Gain support • Address Issues • Communicate Gains TOP 5

  10. Gain support • Establish partners: • Ward leaders - NUMs, CNCs, CNEs, • Delirium & Dementia CNC • Ward ‘champion’ for “Carers as Partners in Care” TOP 5

  11. 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. TOP 5

  12. 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

  13. 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

  14. 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

  15. 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

  16. TOP 5 for CALD Carers Getting Started in SSWAHS Lessons Learnt TOP 5

  17. 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

  18. 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

  19. 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.”

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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.

  25. 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.

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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”

  34. …and more lessons … Establishing Worth & Good Will • Hospitals • Networks – hospital and community networks • Working groups • LHN Executive • Community • General Aged Care • CALD groups

  35. 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

More Related