Background There are unmet palliative care needs in dementia (Van der Steen et al., 2013; Dempsey et al., 2015). The number of people dying with dementia is rapidly increasing (Etkind et al., 2017). Choice in end of life care is a national priority (National Palliative & End of Life Care Partnership, 2015; Department of Health, 2015). NICE Guidance recommends a palliative care approach from point of diagnosis and equitable access to services based on need (NICE clinical guideline reviewed, 2016; Dixon et al., 2015). Electronic care registers (My Care Choices Register in North East Essex) enables recording and sharing of care preferences (Wee, 2015; Department of Health, 2015). Hospices have a pivotal role in sharing palliative care expertise and enabling other teams to incorporate palliative care principles and practices into their work (Calanzani et al., 2013; Hospice UK., 2015). Palliative care teams also need to develop skills in dementia (Van der Steen et al., 2013; Hospice UK., 2015). We therefore developed the Palliative Care and Dementia Project in September 2016.
Aims 1) Develop collaborative working between Palliative Care and Mental Health.
2) Identify unmet palliative care needs in advanced dementia.
3) Increase number of referrals for Dementia patients.
4) Establish use of My Care Choices Register.
Methods Senior Palliative Doctor providing weekly direct support to two Acute Dementia wards over six months. Baseline and subsequent audit of My Care Choices Register registration and hospice referrals. Use of SPICT (10) – Supportive and Palliative Indicators Tool – to aid identification of palliative care needs. 10 hours teaching.
Hospice referrals for dementia patients increased: 2015/16 76; 2016/17 153.
Referrals from mental health increased: 2016/17 one referral; 2016/17 six referrals.
Baseline audit of 24 inpatients demonstrated two were already on My Care Choices Register and mental health ward staff were unaware of this
By May 2017 My Care Choices Register checked for every admission, seven referrals, three received end of life care on the ward.
Issues – pain, agitation, nutrition/hydration, ethical dilemmas, falls, infection, advance care planning, carer burden.
Other outcomes – positive educational feedback, reciprocal job shadowing (nurses), Namaste training (Stacpoole et al., 2015).
Conclusion This project innovatively enhanced collaborative working, increased referrals and established the My Care Choices Register in this setting. Dementia inpatient teams were enabled to improve skills and confidence in providing palliative care. Symptom management was addressed and hospital admissions were avoided for dying patients. Reciprocal educational needs were highlighted. Further work is being undertaken to consolidate this work, identify further dementia/palliative care educational needs and build on the collaboration.
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