Anna Bayes, medical director at Altera Digital Health, explains how Bolton NHS Foundation Trust is enhancing early detection and patient support via electronic patient records.
Dementia is a debilitating condition that affects millions of people worldwide. According to the Alzheimer’s Society, there are nearly one million people with dementia in the UK, and almost half of the population knows someone struggling with a form of dementia.
As the population ages, the prevalence of dementia is expected to increase significantly, with estimates suggesting that by 2040, there will be nearly 1.5 million people living with dementia in the UK. Early detection and management are crucial to ensure that patients receive the best possible care and support.
Following Dementia Action Week, we reflect on the work of Bolton NHS Foundation Trust, a client that has recognised the importance of early detection and management of dementia and is taking steps to improve the care of patients with this condition using our electronic patient record (EPR).
Whenever a patient with dementia is admitted, recording of this diagnosis identifies these individuals through an icon shown on the patient record in the EPR, notifying all clinicians as well as the admiral nurse, no matter what the reason for their admission. This enables proactive input for these patients to provide the appropriate support during their hospital stay and ensures that their dementia needs are considered in their discharge planning.
The role of the admiral nurse
Specialist dementia nurses called admiral nurses play a critical role and support both patients and their families. They offer advice on managing the patient’s symptoms, coping strategies for family members, and information on available resources and support services. By engaging with families early, admiral nurses can provide the necessary support to help them manage their loved one’s care. Hospital admissions are particularly difficult for people with dementia and unfamiliar surroundings can trigger distress, confusion and delirium. This can contribute to a decline in functioning and greatly reduces their chances of returning home to live independently.
David Neilson, admiral nurse at Bolton NHS Foundation Trust, had the following to say: “With the introduction of the electronic referral system across our inpatient wards and emergency department, our aim is for a more rapid response, assessment and support of people living with dementia and their families at the Royal Bolton Hospital.
“With early detection support and signposting to families and caregivers, this aims to improve the patient journey with more support from admission to discharge. The admiral nursing service has always strived to achieve the best standards for our service users and through one-on-one contact, educating and supporting our workforce to give them the skills to achieve excellence in the field of dementia provision.”
Early detection
Assessment tools built into the Sunrise EPR prompt clinicians to screen for delirium and confusion on admission. These tools ensure consistent assessment of potentially treatable causes of acute confusion that can coexist with dementia. This expedites appropriate treatment and support, which can ease their adjustment to being in hospital and ensure plans for discharge incorporate their evolving holistic needs and those of their carers.
The EPR ensures that assessments and plans of all the multi-disciplinary professionals involved are visible for optimal communication and synergised actions.
The dementia referral system in Bolton not only supports patients with dementia but also their families who invariably have many questions and benefit from the experience and guidance of admiral nurses to help families manage their loved one’s care. This includes recording a carer’s assessment in EPR to address the many factors to be considered systematically.
Admiral nurses can help carers navigate the patient’s medical and social issues and can make referrals to specialist medical teams, social care teams and other community organisations, which may support both the patient and the carers/family who may be unaware of resources that can help the family for example, respite care, financial support. These referrals and signposting can help to reduce the burden on families and improve the overall patient and family experience.
Length of stay
Early recognition of dementia, when patients are admitted, can help to reduce the risk of readmission and reduce length of stay. Patients with dementia are more likely to be admitted to hospital than those without the condition, and they are also more likely to experience complications during their stay and minimise complications when they return home. This can help to reduce the pressure on hospitals and improve patient outcomes. For patients who are readmitted, their dementia flag will already be visible reducing any potential lag time in this information being recorded so the admiral nursing team is aware of new admissions.
They can also review the historical records from previous admissions which can help determine any deterioration and provide context for understanding any changes in the carer/ family supporting network.
Admiral nurse efficiency
As their workloads continue to grow, the admiral nurses benefit from the enhanced visibility of patients with dementia and their patients’ progress towards discharge. The EPR also saves them significant time with routine audits that all clinical services must complete by providing a glance assessment of the number of patients living with dementia on each ward and ensuring that each of these patients has had all relevant assessments and interventions based on their needs.
In the past, this would have required locating the patients and then visiting the ward to sift through paperwork to extract the data.
Patient experience
Patients with dementia may struggle with communication and may become agitated or confused in unfamiliar surroundings.
The introduction of the dementia referral system at Bolton NHS Foundation Trust has been a significant step forward in improving the care of patients with dementia and is an excellent example of how healthcare organisations can build in features to their EPR and take steps to improve the care of dementia patients.
By consistently identifying patients with dementia on admission, admiral nurses can provide early support and ensure that patients receive the best possible care during their hospital stays and with the help of their timely, expert support, contribute to reduced length of stay and improved outcomes.
