The Role Of The Dementia Care Home Liaison Nurse Within South East Essex

Jackie Smith Clinical Nurse Specialist Dementia Care Home Liaison Nurse

Background
Pilot study with 4 dementia care homes in 2009 Baseline figures: 136 residents, 84 on anti-psychotics Only 26 had received review of medication No on-going monitoring Referral into secondary care high and could take up-to 12 weeks before review/outcome High usage of other health services Homes felt un-supported Lacked information for alternatives other than medication.

Current Practice Pilot now permanent and has extended to West/South Essex. Currently 3 Dementia Liaison Nurses covering approximately 200 care homes 2 band 7s and 1 band 8 nurses Roles have extended since original pilot Feedback indicates improvement in service A substantial reduction in GP calls A significant reduction in hospital admissions Less medication prescribed for behavioural problems

Aims of Liaison Nurse

To support Care Homes Hospital Avoidance To promote alternatives to antipsychotic use To promote closer integrated working To promote access to Health & Social Care To identify undiagnosed conditions To promote enhanced care End of Life care in dementia Ensure regular reviews including medication (Psycho-tropic medication reviews)

Work of the Liaison Nurse Direct Referrals from Care Homes

Referrals accepted from: GPs, Primary Care, Psychiatrists, Wards, Social Services, Acute Trusts, Fire fighting: behavioural disturbance, Concerns about physical or mental health, Concerns from relatives Mental Health Assessments Medication Reviews Monitoring of anti-psychotics Integrated Working Training

Working Practice
Liaison work in East extended to 20 homes Every resident undergoes a review Each home visited regularly Each home able to contact me directly All newly admitted residents are seen and reviewed Relatives given information All prescribed antipsychotic medication monitored Usage of other professionals Each home offered supplementary training Advice given on managing challenging behaviour Links into local GPs Links into community pharmacists Assistance given to homes in Care Planning Open surgeries for staff/relatives Encouraging homes to use evidence-based tools to support care

Working Practice
Training a big issue Need to Ensure the Following: Changing attitudes Moving away from ritualistic practice Homes taking more ownership Introduction of closer working links Sharing of information with homes Development of more Person Centred care Changes that have occurred Staff protected time Access to community geriatrician/stroke services On-going support More confidence Confidence in managing more challenging behaviour Ensuring Capacity Assessments completed Increase on EOL register Overall reduction of admissions

Anti-Psychotic Prescribing
Any person with dementia prescribed an anti-psychotic undergoes review. Where continuation is required monitoring forms completed Minimum review of 6 weekly maximum of 3 monthly Risperidone drug of choice. Risks discussed with relatives/carers. Side-effects highlighted Staff given information Behaviour charts used Over 500 people being monitored Only 37 on anti-psychotic Noted undiagnosed depression Feedback from GPs very positive Increase of alertness Reduction of falls Better diet/intake reported Increase usage of Memantine 0 referrals into CMHT

On Going Work
How we can support primary Care Reducing unnecessary GP call outs Facilitating referrals Identifying cases for Dementia Register Meeting QOF targets for reviews Reducing use of antipsychotics Improving access to mental health advice, consultation and support Future work? Feedback Excellent Care Homes / Primary Care Qualitative data reported to support impact Awaiting Metrics Possible developments More Liaison Nurses Dedicated Pharmacist hours Monitoring cognitive enhancers

Areas For Further Development

Give the homes the necessary support Identify a standardised training programme Develop a support network for care homes More collaborative working across all professionals (Primary/Secondary/Acute) Expansion of Dementia Care Home Liaison Nurse roles Care Homes to develop non-pharmacological approaches Addressing the environment Sharing of information Implementation of local register of anti-psychotics prescribed for people with dementia Education and training for primary and acute trust staff

Questions?

Thank-you for your time and attention

Jackie Smith Clinical Nurse Specialist Dementia Care Home Liaison Nurse E-mail: Jacqueline.smith@SEPT.nhs.uk