Top 10 things we can do to improve care for older people right now
Mitsuko Nakajima (CMT1), Mary Ní Lochlainn (FY1), James Maguire (Registrar), Myuran Kaneshamoorthy (CT2), Jen Pigott (CT2), James Manger (CT2), Elizabeth Lonsdale-Eccles (CT2), Nivedika Theivendran (CT2), Laura Hill (CT2), Maevis Tan (CT2), Thomas Bell (ST3), Mark Lethby (CT2) & Alvin Shrestha (Clinical Fellow).
On February 6th-7th the BGS (British Geriatrics Society) Trainees Weekend took place in London. At one of the workshops, a group of us looked at how we can influence our colleagues to improve care for older people and also how we can conduct QI projects in non-geriatric settings. The workshop aimed to empower doctors who were not yet on a geriatric medicine training scheme to make a difference, especially where patients were unlikely to be seen by a geriatrician. At the end of the workshop, the group put their heads together to come up with a Top 10 list, of things we can do to improve care for older people right now. Here are the results: https://twitter.com/drohanlon/status/696367027284525056
- Better care planning on discharge and in the community
In hospitals we tend to focus on getting people home, but not think about what happens next. For example, for some people towards the end of their life, re-admission might be the wrong thing – we should put plans in place to make it clear what we think will happen down the line and make sure the patient is aware.
- Use a Communicator if someone has poor hearing!
If you’re on a ward round and the patient clearly cannot hear what you’re saying, just tell your team “Stop!” and get an electronic amplifier with headphones so they can participate in the dialogue. Too many times we write off communication, saying they are “too deaf” to talk to…
- Champion great care, and great carers!
Sign up enthusiastic people who you know provide great care for older people. Make them a champion for dementia, safeguarding, quality improvement, etc. Encourage them to spread good practice so the effect multiplies!
- Reward good practice
If you see great care being provided, make sure you give positive feedback – nominate people who are consistently good for local or national care awards. Make a good example of them, and let them know how valued they are.
- Demystify discharge planning
In the UK we have a section 2, section 5, rehabilitation, reablement, respite, etc. But many people have no idea of what all this means! A helpful OT or social worker could explain all these terms so that doctors who look after older people would be able to help start off the process, and explain to the patient & family what is going on.
- Everyone has a social history
No matter what the reason for admission, we do need to know about home circumstances, mobility, level of independence, care needs and smoking/alcohol history. These are vital, not optional! Don’t let anyone skip this section!
- Take out tubes/lines
We all agreed we had seen patients be told they are ready for discharge, when they ask “What about this tube?” and there is a collective groan as the team realise the patient has a catheter/IV line, etc. At every ward round, we should check what can be taken out, or make a plan for when it can.
- Check hearing aids/glasses/dentures – do they work?
Have you ever been asked by a patient "Who can fix my hearing aid/specs?" or change a battery? If you don’t know the answer, find out so you can finally tell people! These tools are so important to make sure patients are kept well informed about their care, and dentures are vital so people don’t become malnourished in hospital!
- Proactively communicate with the family
This can help in many ways (as long as the patient has given consent): finding out about issues at home, understanding another perspective of a patient’s illness, checking if there are likely to be any obstacles to discharge, and of course giving updates! Most family members are really grateful to be involved in care, especially if a patient has dementia.
- Understand the person behind the patient
Everyone has a story, and finding out about it can help us health professionals to get a richer picture of the person we are looking after. Two excellent suggestions are: getting a photo of the patient from when they were younger, and finding out an interesting aspect of their life. Maybe they fought in the war, wrote a book, or lived in Panama…
This list has been written by doctors who are thinking about geriatric medicine as a career, but haven't yet started their training.
We tweeted it a few minutes after we made it, and already we have had more ideas! https://twitter.com/ArizagaSilvia/status/696429818661875712
https://twitter.com/drnicwatson/status/696385739953741828
We even saw the title spreading in Spanish! https://twitter.com/JPons57/status/696771859501707265
And people picking their favourites... https://twitter.com/blimeysimon/status/696806042244685826
Feel free to add your own in the comments below, or on twitter, Facebook or LinkedIn!
Workshop Facilitators: Tom Bartlett, Joanna Bilak, Rosa McNamara, Sean Ninan, Shane O’Hanlon
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