Maria
Castellucci October 19, 2019 01:00 AM
When persons with dementia are
admitted to the hospital, it can be a traumatic, confusing experience for them
and their families.
Patients with the condition “often
forget where they are and that they are not in their home, so when clinicians
are coming in and out of their room to do their job, it can be alarming. It can
feel like a stranger is coming into their personal space,” said Dr. Maureen
Dale, assistant professor of geriatric medicine at UNC Health Care.
North Carolina has a large
population of residents with dementia that’s only expected to rise. About
160,000 North Carolinians have Alzheimer’s disease, the most common type of
dementia, and the number is projected to increase to more than 210,000 people
in 2025.
State legislators, concerned with
helping those residents and their caregivers, passed a law in 2014 to establish
a task force to come up with a strategic plan. One of the recommendations was
that hospitals train their staff to properly treat patients with dementia.
UNC Health Care, an 11-hospital
system based in North Carolina, took up the recommendation with financial
support from the Duke Endowment, a not-for-profit organization based in
Charlotte that awards grants for issues related to healthcare. The grant is
$720,000 from 2018 to 2021 for the Dementia Friendly Hospital Initiative.
The health system began the
training in early 2019 at its Hillsborough campus, a community hospital with 83
beds. The hospital was selected because it has a geriatric inpatient unit as
well as a geriatric emergency room certified by the American College of
Emergency Physicians.
“It seemed like a good place to
launch the pilot since (the staff) were familiar with the diagnosis,” said Dr.
Jan Busby-Whitehead, chief of the geriatric medicine division at UNC Health
Care.
The training was voluntary. The
geriatric medicine team met with each department, explaining what it would
entail and the benefits. All staff were asked to participate including
environmental service workers, volunteers and phlebotomists. Of the 628
employees at the Hillsborough campus, 519 have completed the training or are
currently undergoing it.
The training had in-person and
online components. The online training involved modules developed by HealthCare
Interactive, which has training programs used by other health systems
nationally.
The modules explain the different
types of dementia, how to communicate with individuals with dementia, the
difference between dementia and delirium, and understanding behavior as a form
of communication.
Dale said developing communication
skills was a big part of the in-person training. Because patients with dementia
are likely to be confused in the hospital setting, much of the training
involved discussing how important it is to introduce oneself when entering the
patient’s room and explaining what they are doing. Skills on how to reorient
the patient calmly were also brought up.
One person in each department was
also selected to reinforce the training in the coming months and years as
staffing changes occur. Dale said their role will “keep the culture change
sustainable.”
The online modules may continue
after the grant runs out to keep the initiative going, Busby-Whitehead added.
Lin Hollowell, director of
healthcare at the Duke Endowment, said the program is meant to be
self-sustaining after the grant funding ends in 2021.
Along with the training, UNC Health
Care changed the menu for patients with advanced dementia. Using cutlery
becomes a challenge at progressed stages of the disease, so finger foods are
given to those patients, Busby-Whitehead said. Additionally, brightly colored
place mats are used to help the patient better distinguish the items on their
tray.
Since the training, many staff
members have said they feel more confident speaking with the patients and
reorienting them, Busby-Whitehead said. She said UNC Health Care also plans to
track performance on 30-day readmissions with this population to see if the
training has had a positive effect.
The grant involves expanding
training to three UNC hospital campuses with large dementia populations, which
the system is now working on, Busby-Whitehead added.
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