Melanie Bunn; geriatric nurse practitioner, a dementia training specialist with Alzheimers North Carolina and an instructor of nurses with Duke University’s School of Nursing, .... her life’s work, ... involves the care and concerns of people with dementia.
Bunn’s role with the Moore Regional nursing staff has focused on building a “care-giving team” with the appropriate tools and knowledge for the individualized care of individuals with “altered mental status.” That can mean the temporary confusion that can accompany an acute illness or the vast mental and physical losses of advanced dementia.
The hospital’s revised protocols on these patients with altered mental status begin at admission during the routine medical assessment that is required of every patient. Patients with an appropriate diagnosis get a gray armband that identifies their altered mental status to the entire care-giving team, and the information is documented in their patient record.
Additional hospital protocols for patients with altered mental status focus on individualized care approaches and specified methods of communication. They also include environmental suggestions for maintaining a “safe, calm, non-threatening environment” such as encouraging frequent family/familiar caregiver visits and avoiding visual and/or auditory elements that could disturb the patient even more.
According to Cheryl Batchelor, R.N., Moore Regional’s executive director of clinical operations, the protocol revisions followed a study of the hospital’s dementia care-giving practices after the husband of an Alzheimer’s patient had raised some concerns.
“He felt we needed to acknowledge the special needs of people with dementia,” Batchelor said. “We thought we were doing a good job, but we were not looking at individualized needs.”
After hearing examples to the contrary during a meeting with the patient’s husband and two other relatives of patients with dementia,
Batchelor, physician champion Jenifir Bruno, M.D., of Hospitalist Services and other members of the FirstHealth nursing staff formed a task force with “cross representation” from all three FirstHealth hospitals.
“We involved as many (disciplines) as possible,” said Tabitha Stewart, R.N., a nurse clinician with Moore Regional Clinical Practice/Professional Development.
Team members reviewed medical literature and contacted other hospitals and various specialists in the area of dementia care. Results included revised educational materials and protocols that were approved by FirstHealth’s Nurse Practice Council.
The admissions database was revised to improve the screening of dementia patients, and the Information Technology department developed a special music-only TV channel for patients who don’t cope well with noise. In addition to Bunn, expert contacts included Dr. Eleanor McConnell of Duke’s Center of Excellence in Geriatric Nursing Education, and Alice Watkins, executive director of Alzheimers North Carolina.
As the various initiatives were rolled out, family caregivers continued to be involved and are pleased with the results. In a recent email, the family member who raised the initial concerns shared the following story about another family:
“At a Dementia Caregiver’s Support Group meeting this week, a participant shared a story about a recent MRH ED visit with her loved one who has dementia. The visit was precipitated by a fall, which resulted in a nasty cut on the forehead. She indicted that he was given a gray wristband. But, more importantly to her, she said the staff seemed much more empathetic to his dementia and accommodating to her than during her previous ED visits, the most recent being about six months ago.
“She additionally noted that upon asking she was allowed to accompany him to imaging where they provided a chair for her while he was given a CT scan.
Read more: Richmond County Daily Journal - Caregivers Family Night to focus on FirstHealth dementia care
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