Jupiter Ward ‘Dementia Care’ Project update report – 6 months in ‘Optimising the therapeutic environment’ Wendy Johnson Matron OPC June 2015
The challenges Patients with some form of dementia make up 25% of adults accessing acute services like GWH – this will rise to 50% within 10 years (Age UK 2014) By 2024 there will be 1.5 million people in the UK living with the disease and by the age of 90, 36% of females and 31% males will have some form of dementia (Alzheimer's society, 2014) In Swindon the numbers of people with dementia is expected to rise by 41% by 2021 Annual cost per patient is £27,647 compared with £3,458 for someone with Heart Disease (Alzheimer's society, 2014) Hospital stays are recognised to have a detrimental affect on people with dementia (Kings Fund 2014) with a greater risk of delirium, prolonged LOS and death (Dementia Action Alliance, 2012)
Why the environment matters: The ‘fear centre’ (Amygdala)
Before the refurbishment
After Refurbishment
The current picture – admissions patients with dementia GWH Apr 2013 – Apr 2015
The Report – June 2015 • Can only suggest but not prove a causal link between outcome and environment • 12 months to track a true ‘trend’ • 6 months post –refurbishment data • Woodpecker as comparator ward • Potential financial impact/Cost savings– To be included in month 12 report (Jan 2016)
6 month outcomes Length of stay (LOS) • Mean length of stay for patients discharged with diagnosis of dementia is decreasing – Mean in 2013/14 was 17.19 – Mean in 2014/15 from Nov-14 to May 15 (after refurbishment) was 16.86 – Decrease of 0.33 days – CONTEXT: – KOPSSU – streaming of more able patients – Growing number of admissions with dementia
6 month outcomes Pharmacological Interventions – frailty indicator Midazolam 5mg/10 Vials per box 20 18 16 14 12 10 Midazolam 5mg/10 Vials per box 8 6 4 2 0 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15
6 month outcomes: Pharmacological Interventions – use of drugs for agitation is down
6 month outcomes Admissions are increasing but use of ‘Close Support’ is reducing Jupiter Ward Close Support hours per month + Numbers of patients with dementia discharged from Jupiter ward May 14 - May 15 1400 25 1200 20 1000 15 Hours 800 600 10 400 5 200 0 0 May June July Aug Sept Oct Nov Dec Jan Feb Mar April May Total Hours assigned 1266 280.5 525.5 200.5 570 617.25 699.75 758 436.75 208 430 55.75 340.25 No's discharged patients 16 16 17 6 16 11 13 18 22 20 12 15 16
6 month outcomes Reduction in total Falls to below average 44% reduction over 12/12 period
The Patient Experience – Significant reduction in care concerns raised by service users 12.00 10.00 Numbers of complaints by month JUPITER COMPLAINT TRAJECTORY 8.00 6.00 4.00 2.00 0.00 Nov 14 - Jan Feb 15 - April Mar - June 2014 July - Oct 2014 2015 2015 Jupiter 9 5 2 1
iwantgreatcare’ feedback 96% positivity rating (April 2015) ‘The staff have been great with my mum. They have gone above and beyond their duties. They deserve recognition and are an asset to the NHS’ ‘The Modern environment’ ‘Noise level reduced’
Outcomes Rolling 12 month figures Staff Turnover
Outcomes – No data available yet • Delirium – Will be collected from August 2015 (Dementia/Delirium CQUIN 2015 - 2016) • Nutrition – multiple variables make this very challenging. Continue to look for a way to measure. May not prove possible
Allied projects coming on-stream 2015 • Music Therapy Twice weekly appropriate age live music (Through volunteer service) MSc. Music therapy students (UWE) from September 2015 (Individual and group work projects) • Social Mealtimes (NESTA)
Thank you for your attention Questions welcome
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