The Doncaster Admiral Service Jo Liversidge Admiral Nurse
How have we got to here? People living with dementia, carers and many other stakeholders, consulted, engaged and involved in creating the Doncaster Dementia Strategy. http://www.doncastertogether.org.uk/images/dementia%20strategy%20for%20doncaster%202015-2017%20final_tcm33-110753.pdf
Getting here... Spirit of partnership Host organisation and the Doncaster Vision Support development
Caseload management Intensive Maintain Hold
Statistics Since 1 ST March 2016 1030 families have accessed the service The largest number of referrals have been self referrals from families of people living with dementia. Referrals also received from CMHT, Social Services, Primary Care services, Parkinson's team and voluntary organisations
Reasons for referral Presence of carer stress, anxiety or depression Need for support with developing skills for caring for the person living with dementia Need for information about dementia service and benefits etc. Complex family dynamics
What? START is an eight session manual based intervention It is provided by Dementia Advisors who have regular supervision From Admiral Nurses Promotes coping strategies for carers of people with dementia Trials at UCL showed this intervention reduced depression and anxiety for family carers The outcome measure for the START programme is the Quality of Life indicator tool
What? START Sessions include: Coping with caring Behaviour strategies and unhelpful thoughts Planning for future Using your skills Reasons for behaviour/ creating a plan Communication Pleasant events and mood Using your skills There is a stress reduction activity attached to each session: Mindfulness Relaxation Guided Imagery
CCG Locality Working Elizabeth Tomlinson Admiral Nurse North West Karen Davies Dementia Advisor South East Hannah Short, Elaine Schofield and Kerry Francis Dementia Advisors Mary Beardsley Admiral Nurse Service Manager Central Joanne Morgan and Elaine Schofield Dementia Advisors North East Stacey Elliott Dementia Advisor Joanne Liversidge Admiral Nurse South West Charlotte Willoughby Dementia Advisor Melanie Metcalf (Administration)
Special Interest Admiral Nurses Each of the Admiral Nurses within the team will have an area of special interest to focus upon: End of Life To explore gaps in current provision for families To facilitate partnerships with hospice/ Marie Curie/Macmillan To create a plan for addressing gaps Rarer Dementia s To include learning disability and dementia Explore gaps in knowledge/services Facilitate screening processes and develop a pathway Coping and Resilience in Families To facilitate the use of programmes designed to support carers Implement START programme To implement couples counselling
How? Close working with people with dementia and their carers Staff being aware of all appropriate services and accessibility Normalisation approach The use of appropriate risk assessment Psychosocial Interventions ICST Masterclass for carers 2 Life story Groups 1 Peer support Group
Accessing the service Referrals 24 hours/7 days From professionals, services, people with dementia and carers/families Single point, phone, email, fax or letter Responded to same day or next working day Mon-Fri 9-5pm with some flexibility Case management
Case Study Referral received from social worker PWD who had a diagnosis of Bladder Cancer Triage assessment undertaken by Admiral Nurse, to enable clearer identification of need- case prioritised Visit arranged Referral also received by palliative Care team and joint working established Joint home visit
Interventions Admiral Nurse 18 point assessment framework carried out, involving the carer in creating a management plan Advice around pain and dementia and considering the bio- psychosocial perspective of the PWD Liaised with Psychiatrist and GP at the request of the palliative care nurse Introduced music therapy
Interventions Advocate for the carer and PWD to receive the appropriate pain relief Provided the carer with education, coping strategies and emotional support.
Outcomes Needs of PWD and Carer identified at point of assessment and addressed Adequate pain relief prescribed and administered. PWD comfortable. Increased awareness and knowledge for the palliative care nurse increased communication Stopped inappropriate referral to Mental Health Service and reduced GP input
Outcomes Music Therapy initially failed wrong song choice however gave the carer a tool to use to provide some mental stimulation and a distraction from the pain PWD received the right pain relief at the right time.
Thank you