175A Novel Pathway to Improve Dementia Care in Acute Hospitals may Require Specialist Nurse Support to Achieve Practice Change

Abstract

Background: Almost 30% of older people admitted to acute hospitals in Ireland have dementia. We introduced a novel dementia pathway in an acute hospital as follows: all older people (.70 years) screened for cognitive vulnerability (delirium, dementia, or delirium on dementia) in ED; patients with dementia received daily delirium screening and a dementia care bundle; enhanced communication with community at time of discharge. The pathway was supported by an extensive pan-hospital education drive and a new dementia nurse specialist (DNS) post. We aimed to assess the compliance with the pathway and explore the effects of the pathway on practice. Methods: Three 'spots' audits were performed at intervals on wards that had implemented the pathway. Twenty case-notes for a person with dementia (any type, any age) discharged between Jan 9th and Feb 20th 2017 were reviewed using the Irish National Audit of Dementia chart review tool; data was compared to 2012 (INAD) and 2014 (baseline) data. Results: Compliance with the pathway was excellent; daily delirium screening and using a patient passport proved most challenging to staff. Practice significantly improved across most INAD parameters. Delirium screening increased from 16% to >90%; recording collateral history of the dementia course increased from 50% to >90%. Assessments for mood, pain, malnutrition all improved. The documentation of dementia stage and delirium occurrence at the time of discharge also dramatically improved. However, much of the improved performance was due to the DNS performing the relevant assessments rather than other staff. Improvements also occurred in wards without the new pathway, again suggesting that the improved care is not solely due to the pathway. Conclusion: A novel pathway for dementia care, supported by a dementia nurse specialist, improves the care of a person with dementia in hospital, but both elements may be necessary for successful practice change.