Inspiration: Pilot – Identification, screening and coding Dementia in the community with direct referral access to memory services for timely diagnosis.
Hounslow and Richmond Community Healthcare Trust
Pilot – Identification, screening and coding Dementia in the community with direct referral access to memory services.
Poor diagnosis rates in Richmond required a new approach in order to achieve timely diagnosis for patients. The pilot aims to support timely identification of possible dementia referred to memory services for timely diagnosis and intervention that is followed by effective care and support for people living with dementia
The Pilot aims to develop a clinical pathway that enables band 6 and 7 Nurses (including Community Matrons ward and community ward nurses) to identify, screen and code patients presenting with possible signs of Dementia in the course of their care of community patient. The nurses will use a basic cognition and memory screening tools (e.g. AMT and or the 6-CIT) to determine if the patient should be referred to the memory service for a full diagnostic assessment.
• Community Nurses who pick up complex and challenging cases in the community and a few senior District Nurses will identify and screen patient that are referred to them for other clinical needs.
• Patients with cognition and memory problems significant enough to impact on their day to day function (who have no other clinical needs and cannot be referred to Community Matrons) identified by Specialist Continence Nurses can be referred directly to memory service.
• Referrals from GPs for dementia screening are excluded from the pilot.
The pilot is a 6 months pilot from September 15th 2014 till March 2015.
Stage of development: –
Mid-point through the implementation of the pilot project.
Initial planning – 6 – 8 weeks
Implementation – 6 months
Evaluation (Including report) – 6 weeks
Challenges In the:-
Planning stage –
• Mapping a pathway that the Nursing staff would engage with i.e. not outside of current commissioned agreements but would meet the needs of the patients and improve the care they received.
• engaging staff
• meeting time scales
• Limited capacity within current Work force – high vacancy rates, demand of several high priorities
• The need to train and ensure all the nurses would use the screening tool accurately and effectively
Features of success: – increasing number of HRCH referrals to memory service that convert to an actual diagnosis
Financial Support:- CQUIN
Outcome of evaluation:- on completion
Area of work
In relation to the four foundations of our declaration, this project aims to:
- Care is about me
- Working as one team
- Happy staff with the right skills
- Make London healthier and happier
Service user involvement?
Not in the pilot. However the pilot was discussed in the Older People’s Mental Health Strategy meeting and had some input from the patient and carer and advocates who are PPI representatives on the meeting.
Advice for others
• Be clear on outcomes and the measurement of outcomes
• Identify additional activity and impact of delivery of new/ changed tasks on current commissioned services and the workforce.