IMPROVING BC’S CARE for PERSONS with DEMENTIA in EMERGENCY DEPARTMENTS and ACUTE CARE HOSPITALS
IMPROVING BC’S CARE for PERSONS with DEMENTIA in EMERGENCY DEPARTMENTS and ACUTE CARE HOSPITALS
Dr. Martha Donnelly
Dr. Janet McElhaney
Marcia Carr, CNS
NOVEMBER 2011
EXECUTIVE SUMMARY[عدل]
Improving BC’s Care for Persons with Dementia in Emergency Departments and Acute Care Hospitals: Findings and Recommendations is the final report of a project that examined the care received by persons with dementia in two particular areas of BC’s health system – emergency departments and acute care hospitals.
As the over-65 population in BC grows, so too will the number of people with dementia. Emergency departments and acute care hospitals are designed to care for patients with specific acute health problems and are not equipped to manage the often complex health issues and behaviour of people with dementia. Health care professionals, as well as families, have recognized that changes to the overall health care system could improve care for people with dementia. Research confirms that the primary issue is that when patients with dementia are admitted to acute care, they often have prolonged stays and worse outcomes than patients with intact cognition.1
This report is the result of a project which included a literature review and ten focus groups – two with family caregivers and six with health care providers – who responded to questions around emergency and acute care for person with dementia. The Improving BC’s Care for Persons with Dementia in Emergency Departments and Acute Care Hospitals Advisory Committee provided ongoing advice and feedback in the development of the report recommendations. Data from the project research literature and focus groups and the expertise of the Advisory Committee members indicates that researchers, families, and health care professionals recognize common problems and know what is needed to improve both the experience and health outcomes of emergency and acute care services for people with dementia. While some of the report findings may appear critical of the current situation, it is important to remember that the identification and analysis of problems is a necessary first step in correcting them and that the focus of the report is on improving care and outcomes for patients with dementia.
Health needs of persons with dementia are complex and interrelated. Improving care for persons with dementia is equally complex with no single or simple answer. Thus, this report offers ten specific recommendations based on project information, selected from the many actions possible to improve care for person with dementia in emergency and acute care settings. These actions were considered achievable in the current economic situation, likely to produce rapid and obvious improvements in care, and their implementation would provide the foundation for further actions.
The five recommendations for improving care for persons with dementia in emergency departments:
- 1. Screen all patients for delirium who show indications of cognitive impairment.
- 2. Provide appropriate triage for patients with dementia and involve specially-trained geriatric emergency nurses where possible.
- 3. Focus on working closely with caregivers as partners in care.
- 4. Follow appropriate guidelines for managing behaviour problems in dementia, starting with non-pharmacological approaches and adding medications as needed.
- 5. Improve training of all personnel in emergency regarding appropriate care for persons with dementia.
The five recommendations with associated strategies for enhancing care for patients with dementia for acute care hospitals are:
- 1. Focus on who the person is by following a person-centered care approach.
- 2. Implement the 48/5 protocol.
- 3. Follow appropriate behavioural protocols for patients demonstrating behavioural or psychological symptoms of dementia.
- 4. Have a policy of minimal restraints.
- 5. Get consumer feedback and consumer involvement in care on the acute care units.
Receiving and providing appropriate care for persons with dementia in emergency and acute care settings is challenging for vulnerable patients and their families and for busy, often unprepared staff. It is hoped that the information and recommendations in this report will clarify these challenges and contribute to improvements that are necessary to ensure that appropriate care is available for persons with dementia when they need emergency or acute care services in British Columbia.
