NHS FORTH VALLEY Integrated Care Pathway For …

1 Version October 2011 Page 1 of 72 UNCONTROLLED WHEN PRINTED NHS FORTH VALLEY Integrated care Pathway For dementia This document can, on request, be made available in alternative formatsDate of First Issue 10/ 10 / 2011 Approved 13 / 12/ 2011 Current Issue Date 10/ 10 / 2011 Review Date 10 / 10/ 2014 Version EQIA 13 / 12 / 2011 Author / Contact dementia ICP Development Group ( Leads- Kate Stoker Shona Mackie and Richard Green ) Contact : Margaret Jamieson ICP Project Developer Group Committee Final Approval ICP Project Board ( Mental Health ) CHP Clinical Governance Committee Version October 2011 UNCONTROLLED WHEN PRINTED 2 NHS FORTH VALLEY Consultation and Change Record Contributing Authors.

2 Dr Richard Coles, Dr James King, Shona Mackie, Linda McAuslan, Lynn Cairns, Richard Green, Alister Edmond, Peter McGlynn, Kate Stoker, Dr Hazel Connery, Dr Peter Murdoch, Margaret Jamieson, Barry Sneddon, Karen Craig, Lindsey Orr, Denise Crawford, Joyce Grant, Gordon McLay, Shona Hogg, Gail McCallum, Dr Susan Angus, Dr Linda Wolff, Ruth Gardner, Lesley Yarrow, Claire Fitzgerald, Ann Haugh. The Learning Disability Service; represented by the Memory Multi-Disciplinary Team (See Appendix 6). Consultation Process: Distribution: Change Record Date Author Change Version Version October 2011 UNCONTROLLED WHEN PRINTED 3 NHS FORTH VALLEY dementia Integrated care Pathway Contents 1.

3 2. What is an Integrated care Pathway (ICP)? ..5 3. Whole System 4. Consent to Treatment, Confidentiality and Decision Making ..6 5. Standard Documentation ..7 6. dementia care 7. Overview of 8. Early Detection, Assessment and 9. Post Diagnostic 10. Anticipatory care Planning (ACP)..16 11. Carers 12. Falls Assessment and 13. Medication used in dementia care and Physical Health Monitoring..19 14. Behavioural and Psychological Symptoms of dementia ..20 Psychological Therapies for Emotional Psychological Interventions for Behaviour that Challenges ..22 Psychological Interventions for Improving/maintaining Cognitive Function.

4 23 Purposeful 15. Prodrome to Early dementia ..25 Assessment, Investigation and Follow up of Subjective Memory Impairment ..26 Assessment, Investigation and Follow up of Objective Memory Older Peoples Services and Learning Disabilities Services Secondary care ..27 Specialist Assessment and Diagnosis ..27 Subjective Memory Impairment (SMI) ..28 Mild Cognitive Impairment (MCI) ..28 Non dementia 16. Moderate Moderate Community Mental Health Services for Older Community Physical Rehabilitation (CPR)..34 Community and Inpatient Podiatry Services (Assessment and Treatment) ..35 17. Acute Inpatient care Moderate 17.

5 1 Principles of Acute Inpatient care for People with dementia ..38 General Hospital care ..38 Acute Psychiatric Inpatient Admission to FORTH VALLEY Royal Hospital ..39 17. 3 The Specialist Acute Physical Health Ward ..40 Old Age Liaison Psychiatry Service and Learning Disabilities Acute Liaison ..43 Nurse..43 17. 5 Ward 4 FORTH VALLEY Royal Hospital Old Age Psychiatry Assessment Unit ..43 18. Severe dementia to Post Severe Assessments, Diagnosis and Interventions for Severe dementia ..50 Long Term Hospital care ..51 End of Life care and Post 19 . Appendix 1 - Assessment Appendix 2- Learning Disabilities Services Flowchart.

6 65 Appendix 3 - ICD 10 Codes and READ 66 Appendix 4 Post Diagnostic Information 67 Appendix 5 - dementia Resource Appendix 6 - BPSD Quick Reference Guide and Appendix 7 - Front Door dementia Version October 2011 Page 4 of 72 UNCONTROLLED WHEN PRINTED 1. Introduction This document provides guidelines to promoting the early detection of dementia and the care and treatment of those with a diagnosis of dementia within FORTH VALLEY through the means of an Integrated care Pathway (ICP). The document has been produced in accordance with the NHS FORTH VALLEY Policy on Developing Guidance (April 2010). 1 The term of service user will be used throughout the document to represent those referred to and receiving care and treatment from a range of Older Peoples Services ( OPS) and Learning Disabilities Services (LDS), except where it is noted that care is provided in an inpatient setting.

7 This ICP was developed using a whole systems approach by ensuring the involvement and consultation of a wide range of services, organisations and individuals who would be affected by the delivery of; or be in receipt of care by way of this ICP. This included input from service users, carers, and members of staff from the healthcare, local authority, voluntary and independent sector organisations within the FORTH VALLEY area. Please note: The blue highlighted text within the document provides access to web-linked appropriate documentation; when read online. Please control and click to open the link if required. This ICP has been developed in line with the: NHS Quality Improvement Scotland Standards for Integrated care pathways in mental health dementia care standards2.

8 Scottish Intercollegiate Guidelines Network (SIGN) 86management of patients with dementia3. National Institute for Health and Clinical Excellence (NICE) clinical guideline 42 on The Charter of Rights for People with Scotland s National dementia Strategy. 6 Standards of care for dementia in Scotland: Action to support the change programme, Scotland's National dementia Strategy7 1 2 3 4 5 6 Version October 2011 UNCONTROLLED WHEN PRINTED 5 " Promoting Excellence: A framework for all health and social services staff working with people with dementia , their families and carers"8 This ICP contains recommendations based on the best available clinical evidence.

9 Some recommendations may be for medicines prescribed outwith the marketing authorisation (product licence). Where a medicine is prescribed outwith the product licence, the prescriber needs to be aware that they are responsible for this decision and must document the clinical need. Where classes of medicines are recommended, atypical antipsychotics, prescribers must acquaint themselves with which medicines are licensed and have Scottish Medicines Consortium (SMC) approval for the prescribed indication. See links to: The electronic Medicines Compendium (eMC) contains information about UK licensed medicines. Scottish Medicines Consortium (SMC): NHS FORTH VALLEY procedures should be followed for the prescribing of unlicensed and non-SMC approved medicines.

10 Please see link to NHS FORTH VALLEY Individual Patient Treatment Request Process Policy. Please see link to Mental Welfare Commission covert medication Pathway : 2. What is an Integrated care Pathway (ICP)? It is an explicit agreement by a local group of staff and workers, both multidisciplinary and multi-agency, to provide a comprehensive service to a clinical or care group on the basis of current views of good practice and any available evidence or guideline. It is important that the group agree on communication, record keeping and audit. There will be a mechanism to pick up when a patient has not received any care input specified by the Pathway so that the omission can be remedied.