Training staff to treat dementia patients
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-White--head added.•