Date post: | 24-May-2015 |
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Implementing the Best care for older people
everywhere: The toolkit
Paulene Mackell Department of Health & The National Ageing Research Institute
–
Improving care for older people in hospital
Improving Care for Older People policy (2003)
COAG LSOP initiative
Improve the capacity of health services to provide more
appropriate care for older people by minimising functional
decline.
Supported by: two key resources
Best care for everyone everywhere: The toolkit
The environmental audit tool
Why develop these resources?
Increasing demand particularly frail older people with chronic & complex conditions
Increasing prevalence of dementia
The rate of fatal adverse events associated with hospitalisation is 10 times higher for people aged over 65 than for those younger than 45
)
Functional decline
• is a reduced ability to perform activities of daily living due to a
decrease in physical or cognitive functioning.
• Approx 34-50% of older patients experience functional decline
in hospitals.
• can occur as early as day two of hospitalisation
• 30% of hospitalised older people, functional decline is
unrelated to their primary diagnosis.
• At 3 months following discharge only 50% of older people
recover from functional decline
Older people in our hospitals
• 42% of adult multiday
separations from hospital are
by patients over the age of 70.
• This accounts for 50% of the
total adult multiday hospital bed
days
• Hospital stays for patients over
85 years account for 17% of
these numbers
• Currently +85 year olds make
up around 2% of the Victorian
population
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
Total seps 2012-13
70+ seps2012-13 2021/22 2031/32
Number of 70+ year hospital separations to total 2012-13. Red line indicates predicted population growth for 70+ years
We also know
• 20% of people in hospital aged over 70 have dementia
• Cognitive impairment is often under recognised in
Australian hospitals
• 10 -22 % of older people have delirium at admission &
a further 2-25% will develop it during their stay.*
• People with cognitive impairment usually present to
hospital for another primary reason.
Contributors to functional decline
• Under-nutrition & dehydration
• Decreased mobility and loss of independence
• Pressure injuries
• Incontinence
• Falls
• Delirium
• Medication errors
• Depression
Prevention
• For patients with cognitive impairment, many of the poor safety
and quality outcomes are preventable
• Earlier & accurate identification
• Comprehensive assessment – involving families
• Modify the environment & implement risk reduction strategies
• http://www.health.vic.gov.au/older/patient-
experience.htm
Evidence Based Improvements
1. Environmental improvements
2. Organisation-wide policy development
3. Models of care
4. Capacity building
An example: Western Health
Evidence : The Toolkit
23 inpatient clinical areas
6170 staff
What are the opportunities to support
workforce
Workforce
• Non-clinical support staff (22%)
• 450 Volunteers
Why was this group the focus of the project?
direct patient, carer and family contact
tended to work in one clinical area: not rotating
had gaps in education
Understanding Dementia Program
• Developed and funded through a dementia fellowship
program.
• Focus on non-clinical (22% workforce)*
• First of its kind in Victoria
• The aim
provide education on how to communicate with
patients with cognitive impairment
to develop a volunteer program to support
patients with dementia in hospital.
Outcomes
• By undertaking these two approaches WH have been
successful in using the Toolkit to:
– Empower and educate staff to improve practice
– Draw on existing staff resources & value their roles
in contributing to improving care
Keeping The toolkit Current
• DH is collaborating with The National Ageing Research
Institute & Victorian health services to review currency
of content & develop e-learning package
• Accessibility
• Toolkit can be accessed: www.health.vic.gov.au/older
• Video material: Patient experience
Sustainability & The toolkit
• Australian Commission on Safety & Quality in Health
Care :
• Mapping between the toolkit and NSQHSS shows
many direct or similar links:
Standard 8
Preventing and
Managing Pressure
Injuries
Sustainability & The toolkit
• Clinical Leadership Group on care of older people in
hospital
• Building a legacy of the Initiative: Share expertise,
knowledge & experience
• RMH EpiCentre are at the initial stage of exploring a
large dementia care pathways project
• The 35 participating health services have built
sustainability into their governance structures and
policy and practice levels