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Challenges in dementia provision – a service that can support you

Challenges in dementia provision – a service that can support you. Sandra Bailey RMN, BSc, Ma, Independent Non-Medical Prescriber Team Leader DIST. Dementia Intensive Support Team (DIST). Secondary Mental Health Service (NSFT) St Clements Hospital Project

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Challenges in dementia provision – a service that can support you

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  1. Challenges in dementia provision – a service that can support you Sandra Bailey RMN, BSc, Ma, Independent Non-Medical Prescriber Team LeaderDIST

  2. Dementia Intensive Support Team (DIST) • Secondary Mental Health Service (NSFT) • St Clements Hospital • Project • Funding - Suffolk CCG/previous Day Treatment Unit

  3. Background • Dementia affects an estimated 670,000 people in England, and the costs across health and social care and wider society are estimated to be £19 billion – both figures are set to rise with the ageing of the population. • Dementia is a significant challenge for the NHS with an estimated 25% of acute beds occupied by people with dementia, their length of stay is longer than people without dementia and they are often subject to delays on leaving hospital.

  4. Background • It is estimated that 25% of general hospital beds in the NHS are occupied by people with dementia, rising to 40% or even higher in certain groups such as elderly care wards or in people with hip fractures. • The presence of dementia is associated with longer lengths of stay, delayed discharges, readmissions and inter-ward transfers. Many admissions are because of ambulatory conditions (about 40%) such as urinary tract or respiratory infections, which can be managed in the community. (Department of Health (2012) Using the Commissioning for Quality and Innovation (CQUIN) payment framework: Guidance on new national goals for 2012-13)

  5. Function of DIST • Reduce/Prevent inappropriate admissions of people with dementia/delirium to acute hospital • Reduce the length of stay in acute hospital of people with delirium/dementia • Reduce/prevent inappropriate admissions of people with delirium/dementia into 24 hour care settings.

  6. Who we are • Registered Mental Health Nurses (x5) • Occupational Therapists (x1.5) • Social Worker (x1) • Assistant Practitioners (x2) • Community Support Workers (x2) • Technical Instructor (x0.6) • Admin Team (x2)

  7. What we do • Hospital referrals – See on ward, attend ward discharge planning meetings, negotiate with client and family, arrange monitoring and support upon discharge, facilitate timely discharge. • Community referrals Assess at current location, support, monitor symptoms, at home, liaise with other agencies/professionals, refer on.

  8. What we actually do.. • Take history.Check for symptoms (MSU, BM levels, arrange blood testing) • Monitor symptoms (improvement/worsening) • Liaise with GPs • Recommend to GPs medication(s) to settle symptoms and monitor efficacy once prescribed

  9. What we actually do • Educate carers on dementia/delirium and how to meet the needs of the client • Work closely with GPs/ACS (including requesting GP visits and/or new/increased care packages to support clients at current time) • Assess mental health need/functioning/safety of client to remain at home at current time (MMSE, ACE-R, HADS, GDS, ADL assessment)

  10. What we actually do… • Stay involved for up to 12 weeks. • Visit daily if needed • Refer to other secondary mental health services if need is clinically indicated • Signposting, advising, co-ordination of treatment, care and care services during time of admission prevention

  11. Who we do this for • People aged 65 years or over with established diagnosis of dementia or with a suspected dementia, and delirium or • People under age of 65 years with established diagnosis of dementia and delirium and • Who are imminently at risk of admission to acute hospital due to acute illness and/or carer breakdown and • are displaying behavioural/psychological symptoms of dementia or delirium (agitation, aggression, increased confusion, hallucinations etc)

  12. Where our referrals come from • GPs • Social Workers • Dementia Advisors/Age UK • Ambulance crews • A&E Department • Acute Hospital Wards • Previous clients/informal carers

  13. What we don’t do • Assessment/Diagnosis (Referrals for this go to Memory Clinic/CMHT via Triage) • Intensive Home Treatment • Crisis Intervention • Assessment/treatment of complex cases or ongoing challenging behaviours associated with dementia

  14. How to contact us • Monday to Friday, 9.00am to 5.00pm • Office Landline – 01473 329820 • Referral line - 07852769172

  15. Thank you for listening Any Questions?

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