Case study:

11 May 2010

Supportive care pathway for use with older people in Birmingham and Solihull Mental Health Trust

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Key points

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Birmingham and Solihull Mental Health Trust Older People’s Directorate has adapted the Liverpool Care Pathway to meet the needs of older people with mental health problems and in particular those with dementia.

The resulting Supportive Care Pathway is a multidisciplinary document, which ensures patients’ needs are reviewed on a daily basis when they are in the terminal stage of their illness.

It covers physical, psychological, spiritual and social needs.

The main aims of the tool, which will be officially launched following a palliative care training day on June 4, are to improve end of life care of patients with dementia, increase staff confidence and support relatives and carers.

It is also hoped the tool will prevent unnecessary out-of-hours admissions to A&E when duty doctors are called in to see patients.

The tool is to be rolled out across the trust’s nine inpatient units although it will be used predominantly in the continuing care units for patients with end stage dementia.

The trust is also developing a long-term pathway with a monthly assessment for those patients with relatively stable palliative care needs.

The Older People’s Directorate developed the pathway following a detailed evaluation of the issues and a survey of staff attitudes.

Staff were asked how comfortable they felt about broaching topics relating to death, dying and bereavement with clients, carers and other colleagues.

Training needs identified included bereavement care, preparing for loss, cultural issues, pain management and living wills.

One of the big challenges in developing a pathway of this kind is that patients with advanced dementia cannot usually communicate how they feel and whether they are in pain.

As a result much is dependent on the staff’s knowledge of the patient and their ability to recognise changes in body language and ‘usual patterns’.

It is therefore important to have regular staff allocated to the patient’s care.

It is also vital to know about the patient’s previous experiences – and tolerance – of pain.

Under the new pathway staff will use pain assessment tools to assess pain – relying not only on their own expertise but that of carers as well.

Further evaluation and audit of the tool will take place once it is in use.

A questionnaire is being developed to gain feedback from carers and patients who were put on the pathway but were discharged from it as they got well.

Staff will also be surveyed.

The pathway is being shared with the Pan Birmingham Network to help in developing a similar tool for use in care homes providing dementia care.

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