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Improving the Dementia Pathway in Camden Learning Disability Service Dr Laura Korb ST5 Psychiatry of Intellectual Disability; Dr Adam Hughes CT3 Psychiatry and Professor Angela Hassiotis Consultant Psychiatrist
CLDS MDT specifically Dr Patsie Leaning, Rebecca Mason, Lynette Kennedy, Elyse Luxon, Dr Jonathan Barnes, Richard Lohan and Sal Bryant
Aim: To apply QI methodology to improve the Dementia Pathway within Camden Learning Disability Service (CLDS). The first QI project within the development of the pathway was focussed on developing a Baseline Clinic for people with Down Syndrome
Background:
People with Intellectual Disabilities, particularly those with Down Syndrome1, have a higher prevalence and a younger age of onset of dementia than the general population. Joint guidelines published by the Royal College of Psychiatrists and the British Psychological Society in 20151 recommend baseline assessments (BA) for every adult with Down Syndrome by the age of 30. NICE guidance (NG96)2 issued in 2018 indicated a need to plan for the future and assess needs early in elderly people with Intellectual disability. It was identified that CLDS required an improved practical evidence based Dementia Pathway.
Methods:
• We held protected regular Multidisciplinary Team (MDT) meetings to value the contribution of various disciplines within CLDS.
• We created a process map for the Dementia Pathway and used QI methodology to test change ideas as each stage of the pathway.
• Our first QI project focussed on the Baseline Clinic.
Process Map:
Discussion and lessons learned:
• The single most affective intervention was allocating assessments to different members of the multi-disciplinary team.
• All the share holders needed to be fully invested in the project
so that the various members of the MDT could be trained.
• The biggest challenge was to get people with busy schedules to meet regularly and have all the disciplines working towards a common goal.
• Involving the MDT made the project sustainable despite changes in staff
Baseline Clinic – Down
Syndrome under 30
Dementia Referral
Memory Assessment
+
Diagnosis
Care Co-Ordinator Allocated
Ongoing Assessment+ Palliative
Care Pathway
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5
No of Baseline Assessments
completed
PDSA Cycle No.
Run chart
PDSA
No.
1
2
3
4
5
Plan and Do
Identify those with Down Syndrome
Consent for Baseline Assessment (BA)
BA on 1 patient (pt)
Train MDT
BA of remaining pts <30
Study
19pts identified
< 30; 34 pts > 30
19 pts contacted. Information requested
Staff feedback
Staff feedback
15 remaining pts allocated for BA.
Act
Start with pts <30 for BA
Develop easy-read leaflet
Make changes to BA
Allocate MDT members to BA
Meet to discuss pts >30
References: 1. NICE Guidance (NG96). Care and support of people growing older with learning disabilities. NICE; April 2018 (cited Sept 2018). Available from:
https://www.nice.org.uk/guidance/NG96 2. RCPscyh, BPS and Division of Clinical psychology. Dementia and people with Intellectual Disabilities. Guidance on the assessment diagnosis,
interventions and support of people with intellectual disabilities who develop dementia. April 2015 (Cited September 2018). Accessed from: https://www1.bps.org.uk/system/files/Public%20files/rep77_dementia_and_id.pdf
PDSA Cycles:
Results:
