CQ 3 Dementia Pathway by 66sU9a0


									                                                                                                                                                                     2010/11 Savings Project Summary

Project Ref                         CQ3                                                                                                                                                                                                                                                                                  ANNEX 6
Project title                       Improving the Experience of Patient with Dementia and their Carers within the Acute Hospital Setting                                 Sponsor                               Maggie Arnold
Division                            Medicine( Trustwide implementation )                                                                                                 Project Manager                       Senior Nurse coordinating Dementia Working Group action plan and activity - Lynne McEwan

Purpose                                                          Spend area                                                                                            Summary of project
Cost reduction                                                    Pay                                                                                                    Please expand this section to access all text -------Improve quality of care for people with Dementia - CQUIN for Dementia agreed on 27th Sept 2010 - wording
Cost avoidance                                                    Non-pay                                                                                                refinements agreed November 2010 by Mrs Arnold and Dementia Commissioning Lead as part of audit proforma planning. Further 20% of payment has been
Income                                                                                                                                                                  allocated by Dementia Commissioning Lead to the CQUIN .
Enabler (LOS, theatres etc)                                                                                                                                              Trust Nursing care plan for 'patient with known dementia' and 'patient with symptoms and no diagnosis' ratified and to be launch Trust wide 16th Nov 2010.Audit
Other (define)                                                                                                                                                           proforma developed by Trust Head of Clinical audit and audit in progress 6th Dec to 17th 2010 for reporting end of Dec 2010. To establish reporting data from Infoflex
                                                                                                                                                                         system regarding GP referral for patients with symptoms of dementia requiring further assessment in Primary Care
                                                                                                                                                                         Develop new Trust wide dementia flow chart/guidance to raise awareness and improve care as part of pathway for patient with known Dementia or suspected
Benefit                                        £,000                                                                                                                    Dementia in all Trust clinical settings. This will then be further developed by partnership working with Primary Care and Community Hospitals as part of the patients
                                                                                                                                                                         Cognitive assessment is a component of the Trust Un-scheduled Care Medical Clerking Proforma and Trust wide Nursing assessment GPP document.
                                                                                                                                                                          Work in progress re Nursing assessment and process for ACU's as GPP not used in these clinical areas for patient admitted for less than 24hours.
                                                                                                                                                                          Appropriate referral to MHLT - Mental Health Liaison Team Operational Policy to be updated in light of changes to Mental Health Liaison Team( Jan 2011).
                                                                                                                                                                         Dementia is a mandatory HRG 10 code. Promote appropriate documentation by Medical Team of diagnosis of Dementia and also for relevant clinical symptom, but
                                                                                                                                                                         where no diagnosis of Dementia to support coding process of secondary or subsequent diagnosis codes for related HRG 10 codes. Work being progresses for this
                                                                                                                                                                         action -Explore process to identify all in-patients with Dementia or suspected Dementia.
Full year benefit                               £309              Recurring                                                                                              Work is in progress with Clinical Information Team re data reporting for Patients discharged with Dementia or other relevant clinical symptoms via related HRG10
                                                                                                                                                                         Assessment against South West Dementia Standards Nov 2010 Version and gap analysis. Carers Survey - Gill Brook Leading on Carers Survey and report. A survey
                                                                                                                                                                         questionnaire has been developed with carers also other methods are being used to seek the views of this group of carers.
                                                                                                                                                                         Identifying carers of in-patients remains a challenge. Protocol for issuing survey packs to carers of in-patients finalised with support of PPI team, Nursing Team and
                                                                                                                                                                         MHL Team. Survey packs delivered to target wards 29th Nov and are also given out by MHL Team. Survey end date 31st Dec 2010. Report results end Jan 2010 .
                                                                                                                                                                         Feedback has been sought from Dementia Commissioning Lead regarding the risk identified relating to potentially not having the required sample of 30 carers who
Part year benefit                                                 Non- recurring
Benefit available from (month)                                                                                                                                           Key assumptions

Project driver                                                   If saving scheme, specify                                       
                                                                  Divisional Savings
1. TMT development
                                                                  Bed usage
                                                                  Theatre utilisation
2. Divisional cost pressure
                                                                  Outpatient utilisation                                                                                 Dependencies
                                                                  Training & Education                                                                                   Requires Trust wide Health Care Team engagement and is dependant upon all clinical teams assessing patients and documenting outcomes. For carers survey
3. Achieving National Standards
                                                                  Medical staffing productivity                                                                          requires that 30 patients admitted with Dementia have a carer, that these carers participate in the survey and return the survey
                                                                  Non pay & Procurement
4. Savings scheme
                                                                  CQUIN                                                           
5. Other development (specify)

                                                                                                                                                                        Rating (1 = low, 5 = high)              1 to 5                                              Status - Red / Amber / Green
Costs                                          £,000              Recurring                                                                                              Challenge                                  5                                                           Amber
Implementation costs                                              Non- recurring                                                                                         Risk to benefits being realised            3

Key milestones/ savings profile                                                                                                                                          Key risks to implementation and/ or benefit realisation
Milestone/ monthly saving profile                                           Owner                 By when                                                                Currently no Trust process to capture data which identifies all in-patients during admission with known or suspected Dementia as not all patients with Dementia require
Action Plan                                                               Maggie Arnold                                         Done                                     to be referred to MHLT, data not captured on PAS IT system during admission episode only captured at discharge via coding - Risk = 5
A) ( Nov 2010)Where patient with known or suspected                                                                                                                      Currently no Trust process to enable identification and reporting of all carers of patients with Dementia during in-patient episode. - Risk = 5
dementia is admitted elective or unscheduled (excludes day                                                                                                               Final CQUIN confirmed 27th September this has an impact on available time to implement new processes Trust wide for audit by end of week 2 December 2010 -
surgery/day unit endoscopy, OPD, E/Dept), a memory                                                                                                                       Risk = 3. Requires that Medical Team assess patients using the Abbreviated Mental Test within the Un-scheduled Care Clerking Proforma. Requires that Nursing
assessment is undertaken using the Gloucester Patient Profile                                                                                                            Team implement the relevant care plan in response to the GPP assessment. The challenge remains identifying sufficient carers of patients with dementia to give valid
(GPP) or other assessment tool as appropriate.                                                                                                                           and reliable data that can be effectively interpreted, not all patients admitted have carers not all carers may wish
• Where the GPP indicator for a known dementia diagnosis,                                                                                                                 to be involved in the survey =5
suspected dementia or assessment of memory scores amber
or red, a dementia or other appropriate care plan is
                                                                                                    20% for receipt in Q3 - for completion of audit by end Q3 2010
• Records include the primary and subsequent diagnosis of         Lynne McEwan and Dementia
dementia, where confirmed                                               Working Group
                                                                                                      30% for annual report and action plan by March 2011 (Q4)
• Appropriate and prompt referral to the MHLT Audit with 4              Representatives
1. Use of GPP Assessment for patients admitted with known or
suspected dementia
2. Patients with Amber or Red GPP Indicator have dementia or
appropriate care plan
3. Confirmed primary diagnosis and subsequent diagnosis of
dementia or related symptoms within records
4. Referrals to MHLT

B) (Nov 2010)GNHSFT will work towards achieving the
identified Hospital Dementia Standards for 2011 (South West       Lynne McEwan and Dementia 30% for Self Assessment and action plan in Q4 /( 30% for Self
Dementia Partnership), providing evidence of quality assurance          Working Group          Assessment in Q4 that demonstrates compliance with core
and processes that are equipped to monitor improved patient             Representatives     standards and includes an action plan for 2011 to meet Level 1.)

C. A carers survey is undertaken that includes;
• Staff attitude
• Carer involvement in planning care
• Information given                                                                                             10% for carers survey completed Q3
• Meeting of patients needs
• Privacy and dignity                                                         Gill Brook
                                                                                                                  10% for report and action plan Q4
 An action plan is developed to improve the experience of
carers of patients with dementia
Carers survey in Q3 of a minimum of 30 carers.
Action plan and evidence of implementation Q4

                                                                                                                                                                                 Date of Checkpoint
Tick to copy & paste                                                                                                                                                                12/15/2010

                    File ref: 1f80cab5-2334-4e95-a67b-125998663238.xls                                                                                                                                                                                                                                                                             CQ 3 Dementia Pathway

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