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Tollerford Surgery: Completed iSPACE Audit Tool (April 2017)

An example of a completed iSPACE audit toolkit from Tollerford Surgery, completed in April 2017.

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Tollerford Surgery: Completed iSPACE Audit Tool (April 2017)

  1. 1. 1 V1 Gold/Platinum status 31/1/17 Name of Surgery List Size The Tollerford Practice 5888 Date of starting iSPACE project No of people with dementia March 2016 35 No of care plans in place 16 Date of Completion of iSPACE No of People with dementia April 2017 Currently coded 48 No of Care plans in place 32  Dementia Diagnosis rates in surgeries adopting iSPACE and across all surgeries in Wessex.  number of primary care staff trained at tier one  % of PWD for whom a carer has been identified  numbers of care plans for people with dementia (PWD) and their review  % admitted as emergency admissions to hospital for PWD compared to the size of the register,  Length of stay in hospital of patients for whom an active care plan is in place  Numbers of primary care consultations by PWD 6 months before iSPACE and 6 months after implementation. IDENTIFY one or two Dementia Champions in the practice Initiative In place Not at this time To Action Identify one or two Dementia Champions GP, Dispenser, Receptionist, HCA, Admin, ACC (Teresa Charles – adult care co-ordinator and carers lead) & assistant Practice Manager Sign up to the Dementia Action Alliance – www.dementiaaction.o Applied and to be a “Safe Haven” and “Find a Loo” when in the area. Start a spreadsheet of all patients who have Dementia in your practice from QOF register Started, still identifying others through checking additional coding. Read the NICE guidance on dementia k/guidance/cg42 Sent to all relevant staff. ACC to f/up with Dementia Champions
  2. 2. 2 STAFF who are skilled and have time to care Initiative In place Not at this time To Action Arrange a clinical meeting for GPs with your local OPMH Consultant to discuss your local dementia pathway and resources available locally GPs discuss patient’s regularly with CMHT at MARM, BIM, VW & S/G meetings. A meeting with just CLINICIANS and CMHT for additional training purposes, may be useful. Discuss further. Review your Dementia QOF template and make it meaningful to patients This is ongoing work which the GPs, Practice Manager and her assistant undertake. Arrange a training session for whole team which focuses on the experience of someone with Dementia – LMCS “lunch and learn” resource pack, Dementia Action Alliance and Alzheimer’s Society are among providers of training. Done in Oct 2016 with Sue Sparks. Certs & Staff Facing Guide given. Prior to that GP did staff training f/up from her own Dementia Training in 2015. Staff encouraged to be Dementia Friends. ACC attended Dementia Conference March 2016. PM & ACC attended BAVLAP meeting 2016 to make “Beaminster And Villages Local Area Planning”, Dementia Friendly. Further information and training updates provided at our monthly staff meetings. Always keep a slot in the agenda for Dementia Champions to raise new concerns or issues and discuss how to overcome. Review Use of antipsychotics and other dementia drugs – audit this See GP audit. Only one CH patient on antipsychotic drug at present. Give each member of staff the booklet “customer facing staff guide” from the Alzheimer’s Society (Costs £5 for 25 booklets) optional Done
  3. 3. 3 PARTNERSHIP working with carers, family and friends Initiative In Place Not at this time To Action Identify carers for all patients with dementia either at the time of referral or from letter back from the memory service. Use consent letter Done. ACC runs Carers register & identifies who they care for, (may not be for patient at our surgery), but will still be in need of support. Each patient is treated as an individual and when the time is right; we will always ask & record patient’s consent to do so, on their medical record. Code the carers and ensure they are included and invited at all stages of the patient’s journey Code with carer’s consent. Staff in regular contact with patients, will (with consent), always offer to liaise with carer or other organisations on their behalf if need to, e.g. Hospital Appt. Involve the patient participation group in this work and ask patients with dementia and their carers what they feel will make the surgery dementia friendly iSPACE to be discussed again at next PPG meeting. Help with Dementia Friendly surgery questionnaire. Provide regular help at our Carers support group. BAVLAP invited to address meeting. Refer the carers to your local carer support agencies Routinely added to GP’s Carer Register, with consent. Encouraged to register as Carer with local Adult Services Dept. ACC already holds a wide selection of information to support individual carers with relevant
  4. 4. 4 issues and current needs. Carers Packs are built around these accordingly. Ensure the carers are copied in to hospital appointment letters so that they are aware of appointment dates (this was the most common request from patients and carers) Whenever possible, consent is obtained from patient, for staff to phone hospitals or include written information regarding family details so that copies of appointment dates can be sent out to carer as well. Give the carer and patient a list of helpful contacts in your area. We have printed this information out on business cards – each area will have different information ACC will regularly contact carers by phone or letter re carer support group dates or to arrange routine follow up. Offer home or surgery, at time of their choosing, to discuss issues further. It may be that a phone call & contact detail for new info is all that is required. Ensure the carer is offered a health check, flu jab and that we remind them that they can take a respite break if needed. This info is reminded to carers by GPs, PNs & ACC upon contact. ACC will even book apts or make initial contact with other agencies, if carer feels they are struggling to do this themselves. Encourage carers to look at the Alzheimer’s Society website and other charity websites to make use of their excellent resources This information is available on our surgery Dementia Leaflet , with other information available in the waiting room, on our website and available direct from ACC. Website needs upgrading, but in hand. We are also pulling together a selection of books for loaning to patients through our surgery library project, ensuring relevance for all ages to be included.
  5. 5. 5 ASSESSMENT and early identification of dementia Initiative In Place Not at this time To Action Encourage a culture where dementia is not stigmatised Awareness day arranged for 13/5/17. Contact made with other local community organisations, including shops, Brownies and BAVLAP for example. To link up with others in the community to strengthen this culture, e.g. Dorset Fire & Rescue Service, local Police CSO, Over 50’s groups, School, Brownies, etc. When someone is concerned about their memory do a formal assessment and refer if needed Already do. Any concerns from any patient, would be dealt with empathetically by surgery staff with suggestion of GP apt or by directing to information resources if preferred. Assessments and referrals made with consent of patient. Reiterate procedure to staff. Be aware of the need to offer early support after diagnosis Recognising Memory Loss day is aimed at raising the importance of this aspect. Audit all codes such as “cognitive decline or mild memory disturbance” to ensure they have been converted to a Dementia code once a formal diagnosis is made **** X***** Work has already started on audit of these codes. GP anticipates completion soon, which will then require our final figures to be updated. Remind all relevant clinical staff to code “cognitive decline” & “mild memory disturbance” and convert to relevant dementia code once formally diagnosed, at next training session. Once coded add a “major alert” to patient notes so that everyone is aware of their diagnosis Routine procedure, but will remind all relevant clinical staff to do this at next training session. **** Remind all relevant clinical staff to add major alerts at next training session Consider if possible to book double appointments for them – they need more time! It is current practice for staff to book dementia patients a double apt, ask how they intend to get to it To write up final protocol, once the technical issues with icons has been resolved.
  6. 6. 6 & if required, offer to liaise with carer or Country Cars. If booked over phone, receptionist will verify carefully with patient that they have written down details correctly & ask to read back. If at reception desk, then will give A4 large print apt slip, adding in any relevant details regarding the apt, in space provided, e.g. write down how to fast for blood test night before or ring Country cars. If people with Dementia are consistently not attending appointments consider contacting them or their carer by phone to remind them of the appointment It is Practice policy to send reception team a scheduled task, to contact patient one hour before their appointment is due with a reminder and check how planning to get there.
  7. 7. 7 CARE PLANS which are person centred Initiative In Place Not at this time To Action Encourage patients to complete a personal care plan such as the Alzheimer’s Society “this is me” document in advance of their review appointment Care Plans have doubled since iSPACE implementation and there are “this is me” documents available at the surgery. Encourage patients and their carers to express their care needs at an early stage so that we make best use of the window of opportunity. Anticipatory care plans are very helpful We also have Advanced Care Planning booklets available at the surgery for patients to express their anticipatory care plans, when able to do so. Be aware of the natural stages of Dementia and the symptoms of advanced Dementia All staff have relevant training for their role and this is updated annually. Identify those patients who are progressing and ensure we link up with social care and add patients to the multi-disciplinary meeting list As a working team, these patients are flagged up with other relevant staff at the Practice and added to our VW or S/G patient lists, to ensure discussed at multi- disciplinary level. Refer on to Dementia “post diagnosis support services” This is done as a matter of course by each GP, as situations arise. Complete the advanced care plan – a DES requirement This is also raised by the GP and there are booklets available in the surgery waiting room.
  8. 8. 8 ENVIRONMENTS that are dementia friendly Initiative In place Not at this time To Action Good lighting, a welcoming face at reception and a sense of calm In place. Slowly changing over to daylight bulbs, with limited noise disturbance and low visual distractions. Remind staff of this important factor when at monthly training. Read examples of what may cause anxiety to patients Use of bright colours for the staff uniforms – pink and red have been successful No current uniform & discussed. Staff aware to put patients at ease for happy experience. To remind on training days. Consider making the surgery a safe haven for people who are found wandering in the area Applied for this and small lunch box, limited change of clothing and basic games, puzzle, book activities to occupy. Uncluttered floor space and plain carpets In place, although MN have a play mat in children’s corner. Clear signage for toilets and exits - use symbols Done & on approach to front door, painted white edges & steps. Arrange for a person with dementia and their carer to do a walk round of the surgery - either one of your patients or a “mystery shopper” who the WAHSN will invite Arranged before iSPACE implemented and will invite same patients back for return visit and further opinion. Ask the Patient Participation Group to get involved with the project - to undertake the Kings Fund – is your health centre dementia friendly – audit and survey of patients and collaborate on creating leaflets and any other actions such as starting a carers drop in every 2 to 3 months. The PPG will be invited to participate in the survey of dementia patients & carers. They are already involved with our carers drop in and some are vetted to deliver medication supplies to the housebound. This is also valuable regular contact for patient & feedback for surgery.
  9. 9. 9 Members are also involved with private prescribing, e.g. local walking group, Local Initiatives – Please use this space to detail any other ideas/plans you may have The Tollerford Practice has been involved with a research project run by Integraal, through DCC. The aim being to see how technology can help and support patients living with dementia to remain safe and well at home. They do not necessarily have to be able to use it themselves, but The circle of care around them at different levels of confidentiality can keep family informed of the patient’s activity or visitors for the day. Surgery & PPG to support BAVLAP with their initiative to make Beaminster Area and surrounding Villages dementia friendly. PPG to support, promote and help raise awareness at Recognising Memory Loss day 13/5/17, held by the Tollerford Practice. Many local organisations invited from Brownies to local PCSO, plus organisations such as Alzheimers to run Dementia Friends sessions and Dementia UK to talk about Admiral Nurses. Also CAB or Age UK to inform re legal / financial aspects such as Power of Attorney. Plus Activities and Crafts to be involved with. Invite local singing group. Advertise well. The PPG are working with us on ‘Social Prescribing’. The first part of this has been to set up ‘health walks’, which is supported by the organisation ‘walking for health’. The walks would be led from the surgery and patients return for tea/coffee. We are sure this will be of benefit to some of the more ambulatory dementia patients. The walks will be on prescription and referred by the GP to make sure that the most appropriate patients are referred. We need to support Age UK with their voluntary Good Neighbour Scheme as so many of our patients lack companionship when sitting at home alone, to give a carer some valuable respite, if needing assistance with shopping or are still active enough to want to go for a long walk. Support “Forget Me Not” icon for patient alerts on S1. Future Planning: Dispensary labels and information to be made clearer for patients. Make dementia patients more obvious to staff for when handing out medication, so they can discuss carefully and ensure patient understands directions. Dispensary staff, GPs and Nurses to ensure easy to use appliances available and techniques demonstrated with patient and follow ups made. Blister Packs already available, to aid compliance. Upgrade and advertise on website. Insert to be added to website when iSPACE complete. Working with member of PPG to create much clearer, concise and simplified notice board information.
  10. 10. 10 Completion of surgery library resources for patient’s to borrow, whether medical condition, bereavement or dementia. All ages considered. Photographs were taken before and will be again at completion. Await automation of our front entrance doors and new signage at entrance from road. The surgery waiting room chairs will slowly be reupholstered in bright wipe able material. Some have arms, some do not. Textured wall rail along length of corridor to reinforce way back to reception. Future Training: CD / video to be shown, discuss how to improve aspects of our day to day working to help Dementia Patients & Carers. Further training on Carers too due for June 2017. Further Dementia Friend training available at our Memory Loss day 13/5.
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