Improving the admission and discharge practices of acute and sub-acute care facilities in relation to people with dementia - (Electronically Published June 2003)

This was a four-phase project aimed at increasing the extent to which the care of people with dementia who are admitted to, or discharged from acute and sub-acute care facilities in Victoria is based upon the best available evidence. The project was funded by the State Government, Department of Human Services and involved facilities throughout metropolitan and country Victoria.

Project Aims

The specific aims of this project were to:

• identify best practice (evidence-based) in relation to the admission and discharge of people who have dementia through the conduct of a series of concurrent systematic reviews, broad literature review and expert opinion
• develop tools which would facilitate the identification of evidence-based practice (EBP) and those structures, processes, policies, practices and cultures that support EBP in practice settings
• increase understanding of the structures, processes, policies, practices and general cultures that support EBP in relevant practice settings
• describe and evaluate guidelines for increasing EBP in two practice settings (acute and sub-acute care) related to dementia care.

Conclusions

This project aimed to establish indicators of EBP in relation to acute and sub-acute admission and discharge of people with dementia. The Evidence-based Identification Tool (EBIT) fulfills this purpose. At this stage, work has not been done on weighting the items and so it is more informative to compare each item across audits rather than simply look at the overall score.

Although the focus of this project was on admission and discharge, many of the indicators are equally important, or specifically related, to inpatient care. The EBIT proved useful in assisting facilities to identify the areas of their practice where they were doing well and those that needed improvement. It also acted as an educational tool and something of a map to guide facilities in terms of priorities for improvement and change implementation strategies. The action research studies provided excellent examples of how facilities could actually use the EBIT to improve practice.

It became clear during the study that, at least in the current context, primary nursing is neither feasible nor necessary to provide individualised, continuity of care and that properly organised team nursing – if it was person-centred rather than task oriented - could meet these underlying principles of care while also providing a feasible and appropriate model for contemporary practice.

Not surprisingly, acute facilities did not rank most of the items related to care of people with dementia as highly as did sub-acute facilities. It would be useful in the future to compare the rankings of the EBIT items undertaken by the participants in this study with how ‘experts’ ranked them. The results of Phase 4 of the project provide some direction in terms of what education and change is required across the sectors if the health care experiences of people living with dementia and their families are to improve.

Further work on the EBIT could improve its validity and reliability and potentially reduce the number of items. The outcomes of this project suggest that a shorter tool would be appropriate for simple audits and quality improvement exercises, however, the longer EBIT has a role as an educative tool.