An Innovative Approach to Managing Behavioral and Psychological Dementia

The older adult population in long-term care is experiencing significant growth, which includes an increased number of minority admissions. An estimated 48% of long-term care patients are admitted with a diagnosis of dementia | The Journal for Nurse Practitioners

Highlights: 

  • Nurse practitioners are in a key position to provide culturally appropriate care in older adults with BPSD
  • Personalized music is an evidence-based, patient centered intervention to reduce BPSD
  • Regulatory agencies are closely monitoring the management of BPSD in long-term care facilities.
  • Personalized music can be an interdisciplinary approach in the management of BPSD

Patient-centered, culturally appropriate care is critical in the management of dementia and treatment of associated behavior and psychological symptoms of dementia (BPSD). The use of personalized music playlists has shown promise in the interdisciplinary treatment of BPSD. Regulatory agencies are closely monitoring the management of BPSD. Accurate diagnosis and treatment of BPSD is an increasingly important skill for the provider.

Full reference: Long, E.M. (2017) An Innovative Approach to Managing Behavioral and Psychological Dementia. The Journal for Nurse Practitioners. Vol. 13 (Issue 7) pp. 475-481

Enhancing Patient Safety Through Physician Health and Well-being Research.

Keeping medical practitioners healthy is an important consideration for workforce satisfaction and retention, as well as public safety | Journal of Patient Safety

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However, there is limited evidence demonstrating how to best care for this group. The absence of data is related to the lack of available funding in this area of research. Supporting investigations that examine physician health often “fall through the cracks” of traditional funding opportunities, landing somewhere between patient safety and workforce development priorities. To address this, funders must extend the scope of current grant opportunities by broadening the scope of patient safety and its relationship to physician health. Other considerations are allocating a portion of doctors’ licensing fees to support physician health research and encourage researchers to collaborate with interested stakeholders who can underwrite the costs of studies. Ultimately, funding studies of physician health benefits not only the community of doctors but also the millions of patients receiving care each year.

Full reference: Brooks, E. et al. (2017) Investing in Physicians Is Investing in Patients: Enhancing Patient Safety Through Physician Health and Well-being Research. Journal of Patient Safety: Published online: July 20, 20.7

New framework to promote person-centred approaches in healthcare

Skills for Health, Health Education England and Skills for Care have announced a new Framework to support person-centred approaches for the health and social care workforce | Skills for Health

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Image source: Skills for Health

This approach, outlined in the Five Year Forward View, puts people, families and communities at the heart of health, care and wellbeing. It encourages people to speak with staff about what is important to them, helping to develop a shared understanding of what matters to them.

The new framework, commissioned by Health Education England, helps workers communicate meaningfully both verbally and non-verbally, tailoring the care and advice they give to suit peoples’ needs. It supports individuals to better manage their own health and wellbeing through bespoke care, planning and support. Where appropriate, the framework encourages shared decision making, outlining all reasonable options and ensuring that all information is personalised, accessible and useful.

Practical value in the NHS

The King’s Fund has previously highlighted the fact that addressing waste and variability in clinical work can create better value in the NHS. But what does value mean to people working in the NHS – and how it is being applied in practice? | The King’s Fund Blog

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‘Value’ sounds like a familiar concept but it can mean different things to different people. One definition of value in the health and care sector is ‘health outcomes per dollar spent’, so attempts to increase value can look at either improving quality or reducing cost.

In early July we held a roundtable discussion with health service providers to better understand their approach to value improvement – initial research for a new project intended to understand the practical barriers and challenges that frontline clinical, operational and managerial leaders have encountered in pursuing better value health care. Experts who attended – including a chairman, chief executive, chief nurse, deputy chief operating officer, change leader, and representatives of national bodies – agreed that the emphasis should be on patient care. Clinicians are more likely to engage in a programme that revolves around the quality of services, and better care is typically less wasteful, so as one participant put it, ‘if you focus on quality, money will fall out’ [spending will reduce]. Consultants will often drive through successful programmes with change management teams, but we also discussed the role of junior doctors, nurses and therapists, who frequently witness low-value care and understand how to fix it. We know that substantial changes in practice can be delivered as we have seen, for example, in generic prescribing, reduced length of stay and the move towards day case surgery.

Read the full blog post here

Investment in NHS transformation projects

Secretary of State for Health and NHS England have announced £325m of capital investment for local projects that will help the NHS to modernise and transform care for patients.

Patients will see this investment deliver faster diagnosis for conditions like cancer, easier access to mental health care, expansion of A&Es, shorter waits for operations, and more services in GPs surgeries. This initial tranche of funding has been targeted at the strongest and most advanced schemes in STPs.

Read more via NHS England

Additional link: RCGP press release

Quality improvement in mental health

Quality improvement in mental health | The King’s Fund

This report explores the potential opportunities arising from the application of quality improvement approaches in the mental health sector and identifies relevant learning from organisations that have already adopted these approaches.

The authors were specifically interested in understanding how and why some mental health organisations have embraced quality improvement strategies and what has enabled them to do so. It explores what changes are needed from senior leaders to cultivate a quality improvement ethos within their organisation.    

Key findings

  • Embracing quality improvement requires a change in the traditional approach to leadership at all levels of an organisation, so that those closest to problems (staff and patients) can devise the best solutions and implement them.
  • Doing quality improvement at scale requires an appropriate organisational infrastructure, both to support frontline teams and to ensure that learning spreads and is taken up across the organisation.
  • Tools and approaches used in the acute hospital sector can be adapted for use in mental health care, including in community settings.
  • Success is most likely when there is fidelity to the chosen improvement method, and a sustained commitment over time.
  • The strong emphasis on co-production and service user involvement in mental health can be harnessed as a powerful asset in quality improvement work.

Download the full report: Quality improvement in mental health

The care of older people in care homes

National Institute for Health Research (NIHR) Themed Review: Advancing Care: Research with care homes

There are more than twice as many people living in care homes in England and Wales, than there are people staying in hospital. Yet we know far more about effective treatments in hospital and less about what works most effectively to improve care for older people in care homes. Research in care homes is a relatively new and emerging field.

Advancing Care provides an overview of recent NIHR research on improving the health and care of care home residents. It highlights current research taking place now and explores new approaches being developed in this important area.

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Image source: http://www.dc.nihr.ac.uk

The review brings together NIHR research on three themes relating to the care of older people in care homes: Living well – maintaining good health and quality of life, ageing well – managing long term conditions associated with ageing, and dying well – ensuring a good quality end of life. It features:

  • 23 published studies
  • 21 ongoing studies
  • Quotes from care home owners, managers, staff and researchers
  • Where next for care home research?

Involving staff with quality improvement initiatives

NHS Employers has published Staff involvement, quality improvement and staff engagement:  the missing links.

This briefing aims to help managers and leaders understand more about how involving staff with quality improvement initiatives can have a significant impact on staff engagement levels.

Involving staff in quality improvement decision-making, planning and delivery has always been a good idea. However, at a time of unprecedented pressures and financial challenges it is an issue of the highest importance.

This new briefing explores the benefits, approaches and working examples of how organisations are involving staff with their quality improvement activities.

Read more about staff engagement initiatives across the NHS here.

People with dementia benefit from goal-oriented therapy

Personalised cognitive rehabilitation therapy can help people with early stage dementia significantly improve their ability to engage in important everyday activities and tasks. | via ScienceDaily

A large-scale trial has found that cognitive rehabilitation leads to people seeing satisfying progress in areas that enable them to maintain their functioning and independence.

Cognitive rehabilitation involves a therapist working with the person with dementia and a family carer to identify issues where they would like to see improvements. Together, they set up to three goals, and the therapist helps to develop strategies to achieve these goals.

The goals participants chose were varied, as dementia affects people in a wide range of ways. Some participants wanted to find ways of staying independent, for example by learning or re-learning how to use household appliances or mobile phones. Some wanted to manage daily tasks better, and worked with therapists on developing strategies to prevent them burning their food when cooking meals. Others wanted to stay socially connected, and focussed on being able to remember details like the names of relatives or neighbours, or improving their ability to engage in conversation. Sometimes staying safe was important, so strategies focused on things like remembering to lock the door at home or withdrawing money safely from a cashpoint.

The Goal-oriented Cognitive Rehabilitation in Early-stage Alzheimer’s and Related Dementias: Multi-centre Single-blind Randomised Controlled Trial (GREAT) trial involved 475 people across eight sites in England and Wales. Half of them received ten cognitive rehabilitation sessions over three months, and the other half did not. The group receiving the therapy then took part in four “top-up” sessions over six months.

The researchers found that those who took part in the therapy showed significant improvement in the areas they had identified, after both the ten week and “top-up” sessions. Family carers agreed that their performance had improved. Both participants and carers were happier with the participants’ abilities in the areas identified.

Full story: University of Exeter. “People with dementia benefit from goal-oriented therapy: Personalized cognitive rehabilitation therapy can help people with early stage dementia significantly improve their ability to engage in important everyday activities and tasks.” ScienceDaily. | 18 July 2017.

The realities of partnership in person-centred care

Although conceptual definitions of person-centred care (PCC) vary, most models value the involvement of patients through patient-professional partnerships | BMJ Open

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Objective: While this may increase patients’ sense of responsibility and control, research is needed to further understand how this partnership is created and perceived. This study aims to explore the realities of partnership as perceived by patients and health professionals in everyday PCC practice.

Conclusions: In our study, patients appear to value a process of human connectedness above and beyond formalised aspects of documenting agreed goals and care planning. PCC increases patients’ confidence in professionals who are competent and able to make them feel safe and secure. Informal elements of partnership provide the conditions for communication and cooperation on which formal relations of partnership can be constructed.

Full reference: Wolf, A. et al. (2017) The realities of partnership in person-centred care: a qualitative interview study with patients and professionals. BMJ Open. 7:e016491