Locality-Led Adoption Post Pilot of the Greater Manchester Delirium Toolkit
Highlighting the successful pilot of the Greater Manchester Community Delirium Toolkit led by local teams in various regions. The toolkit aimed to standardize screening, assessment, and management of delirium, resulting in improved quality of care, proactive follow-up, timely treatment, education for patients and families, and a reduction in hospital admissions. The pilot evaluation report showcased the significant benefits delivered, emphasizing the importance of community-led initiatives in healthcare.
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HEAT MAP: HIGHLIGHTING LOCALITY-LED ADOPTION POST PILOT OF THE GREATER MANCHESTER DELIRIUM TOOLKIT Updated November 2021
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership GREATER MANCHESTER COMMUNITY DELIRIUM TOOLKIT Greater Manchester-wide stakeholder engagement to develop a community toolkit Dementia United hosted free World Delirium Awareness Day events 2018, 2019, 2020 (80 plus delegates attended). Dementia United harnessed engagement, raised awareness and agreed priorities for the programme of work Co-produced resources; involving clinicians from primary/acute care, mental health, allied health professionals, providers such as care homes, people with lived experience and voluntary/community groups What were the goals of the toolkit? To improve detection; to reduce the variation across Greater Manchester by offering a standardised approach to screening, assessment, identifying causes, treatment and management of delirium To safely manage people at home; to improve health/care staff, public and family members understanding of delirium, which included a focus on prevention Dementia United were asked to expediate having the Toolkit available during the pandemic. Engaged with established community teams who would be happy to pilot; supported by Dementia United governance/ Greater Manchester Primary Care Cell in April 2020 Piloted the Toolkit July December 2020 The following teams engaged in the pilot; Trafford Community Enhanced Care Service, Salford Urgent Care Team, Bolton Admission Avoidance Team, Stockport Victoria Proactive Care primary care network, Intermediate Care - Manchester Gorton South bed based/community Aim of the pilot; to understand if the toolkit could be implemented across Greater Manchester , identifying resources needed, to consider whether the toolkit would deliver the intended goals Dementia United provided support with fortnightly drop-in sessions for the teams piloting
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership BENEFITS DELIVERED BY THE GREATER MANCHESTER COMMUNITY DELIRIUM TOOLKIT Improved quality of care as patients presenting with acute confusion were screened using a standardised 4AT (156 patients screened for delirium) Proactive follow-up and onward referral as needed for people with delirium who remained at home. Timely standardised identification of causes of delirium and commencing treatment (87 patients with delirium) Education and information for people who experience delirium and families, with the provision of the leaflet. Reduction in admissions to hospital as 70% remained at home (61 patients) Proactive prevention for patients who are at high risk of developing delirium. Pilot evaluation can be accessed via the link here Greater-Manchester-Community-Delirium-Toolkit-Pilot- Report-March-2021-1.pdf (dementia-united.org.uk). Link here to the GM Community Delirium Toolkit Greater Manchester Community Delirium Toolkit - Dementia United (dementia-united.org.uk) Link here Delirium toolkit training resources - Dementia United (dementia-united.org.uk) to training resources that Dementia United collated to support the Pilot. This includes translations of the public facing delirium leaflet.
Dementia United Greater Manchester Health and Social Care Partnership GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION IMPLEMENTATION OF THE COMMUNITY DELIRIUM TOOLKIT POST PILOT Locality-led Following the success of the pilot, there have been great examples, of the Pilot community teams, leading on the adoption in their localities of the Greater Manchester community delirium toolkit Dementia United, working with these locality teams, have created a heat map showing the levels of adoption across Greater Manchester Using the Stages of Adoption taken from the Patient Safety Network - Health Innovation Manchester, a heat map has been developedwhich shows the locality-led adoption of the Greater Manchester community delirium toolkit The delirium heatmap, will form part of Health Innovation Manchester s overarching programme on the patient safety network (please refer to the end slide for the details of the network) The heat map that follows for the locality, shows the adoption across Greater Manchester of the community delirium toolkit for each quarter from April 2021. For example, quarter 1 reflects the position for each locality at the end of June 2021. Dementia United, working with the localities will update the heat map on a quarterly basis e.g. next update will be at the end of quarter 2 including Oct 2021(Nov 2022), end of quarter 3 (early Jan 2022), end of quarter 4 (early April 2022)
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership STAGES OF ADOPTION Stage 3: Decision The organisation has decided whether this would be worth pursuing further Stage 0: No Contact The organisation has not been contacted or has yet to respond to contact made Stage 2: Interest The organisation s interest in the intervention has been gauged Stage 1: Knowledge The organisation is aware of the intervention Stage 7: Sustained The intervention has become integrated into practice for over a year in all appropriate settings of the organisation Stage 6:Spread The intervention has been spread and adopted in all the appropriate settings of the organisation Stage 5: Adoption Part of the organisation has adopted the intervention Stage 4: Testing or implementation Part of the organisation is testing or implementing the intervention Stages of adoption legend with thanks and acknowledgement to the Patient Safety Network, Health Innovation Manchester
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership Bolton Quarter 1 Admission Avoidance Team Advance Nurse Practitioners Wider Admission Avoidance Team Connecting with others in locality e.g. Emergency Department, Bolton General Hospital, Quality Lead, Mental Health Later Life Adoption stage 6: Spread Adoption stage 4: Test/implement Adoption stage 1: Knowledge Bolton Quarter 2 Admission Avoidance Team Advance Nurse Practitioners Wider Admission Avoidance Team Connecting with others in locality e.g. Emergency Department, Bolton General Hospital, Quality Lead, Mental Health Later Life Adoption stage 6: Spread Adoption stage 4: Test/implement Adoption stage 1: Knowledge
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership Bury Quarter 1 Adoption stage 3: Decision GP Uplands Medical Practice Wider Primary Care Network Adoption stage 1: Knowledge engagement Bury Quarter 2 Adoption stage 4: Test/implement GP Uplands Medical Practice Uplands and Whitefield Neighbourhood Locality includes GPs, primary care and community teams Northern Care Alliance; offer of training to Fairfield hospital, Community staff that includes the Toolkit Intermediate Tier: including Rapid Response, Reablement, Discharge to Assess Wider Primary Care Network Engagement Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 1: Knowledge
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership Heywood Middleton and Rochdale Northern Care Alliance; offer of training to Rochdale hospital, Community staff that includes the Toolkit Six Integrated Neighbourhood Teams (INT): Advanced Clinical Practitioners as part of phased implementation plan for the INTs Quarter 2 Adoption stage 4: Test/implement Adoption stage 3: Decision Care Homes MDT Adoption stage 2: Interest Adoption stage 1: Knowledge Rapid Response Team
Dementia United Greater Manchester Health and Social Care Partnership GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Manchester Intermediate Care - Gorton South, central Crisis Response Team central Discharge to Assess team - central GP engaging with care homes North Manchester Mental Health Later Life team Quarter 1 Adoption stage 4: Test/implement Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 1: Knowledge Manchester - Central Quarter 2 Intermediate Care - Gorton South Crisis Response Team - Advanced Clinical Practitioners Discharge to Assess team Adoption stage 4: Test/implement Adoption stage 3: Decision Adoption stage 3: Decision Mental Health Later Life team Adoption stage 1: Knowledge Manchester - North GP engaging with care homes Crisis Team Advanced Clinical Practitioners. Reactive Care Homes Service Mental Health Later Life team Quarter 2 Adoption stage 2: Interest Adoption stage: Interest Adoption stage 1: Knowledge Manchester - South GP Kingsway Medical Practice Adoption stage 2: Interest Mental Health Later Life team Quarter 2 Adoption stage 1: Knowledge
Dementia United Greater Manchester Health and Social Care Partnership GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Oldham Quarter 2 Adoption stage 4: Testing or implementing BAME Dementia Advisor; implementing use of leaflet and translated resources Northern Care Alliance: Royal Oldham Hospital; Lead Dementia Practitioner and Registrar Adoption stage 3: Decision Memory Assessment Services Adoption stage 3: Decision Care Homes Mental Health Liaison Service Adoption stage 2: Interest Community Mental Health Teams Later Life Adoption stage 2: Interest Community services within Northern Care Alliance via the Lead Dementia Practitioner and Frailty colleagues; Crisis team, Intermediate Care, District Nurses, Falls team Adoption stage 2: Interest Dementia Locality Lead/CCG Commissioner Adoption stage 2: Interest Inpatient wards Later Life Mental Health Adoption stage 2: Interest Age UK Adoption stage 2: Interest
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership Salford Quarter 1 Adoption stage 6: Spread Adoption stage 5: Adoption Urgent Care Team Salford Quarter 2 Adoption stage 6: Spread Adoption stage 5: Adoption Adoption stage 5: Adoption Intermediate Care bed based Urgent Care Team Connecting with others in locality e.g. District Nurses Adoption stage 2: Interest Northern Care Alliance: within the acute hospital Intermediate Care bed based over 4 wards Northern Care Alliance Salford Integrated Foundation Trust in the community; offer of training for staff and support use of Toolkit Connecting with others in locality e.g. with District Nurses Northern Care Alliance Salford Integrated Adoption stage 2: Interest Foundation Trust in the Adoption stage 3: Decision community Adoption stage 2: Interest Adoption stage 1: Knowledge Memory Assessment Service
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership Stockport Proactive Victoria primary care network District Nurses Stockport wide following train the trainer of 8 neighbourhood locality teams. Working in collaboration with Crisis Response Team Stockport Crisis Response Team; including drafting and sign off of a Standard Operating Procedure in collaboration with District Nursing teams Mental Health Liaison Services linking with District Nurses, Crisis Quarter 2 Adoption stage 6: Spread Stockport Proactive Victoria primary care network Mental Health Liaison Services linking with District Nurses, Crisis District Nurses Stockport wide Stockport Crisis Response Team Matron Dementia Care, Acute Hospital GP Heald Green practice Clinical Commissioning Group education lead Quarter 1 Adoption stage 5: Adoption Adoption stage 5: Adoption Adoption stage 5: Adoption Adoption stage 4: Test/implement Adoption stage 4: Test/implement Adoption stage 5: Adoption Adoption stage 5: Adoption Adoption stage 4: Test/implement Adoption stage 3: Decision Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 3: Decision Discharge to assess team Adoption stage 2: Interest Matron Dementia Care, Acute Hospital Adoption stage 2: Interest GP Heald Green practice Clinical Commissioning Group education lead
Dementia United GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Greater Manchester Health and Social Care Partnership Tameside Quarter 1 Stalybridge Primary Care Network Adoption stage 1: Knowledge Adoption stage 1: Knowledge Glossop Ageing Well Team Tameside Pilot use of 4AT on medical wards; led by trainee Advanced Clinical Practitioner Older People s Mental Health (OPMH) inpatient wards e.g. Summers and Hague Memory Assessment Services; Whittaker Day Services (OPMH) OPMH Home Intervention Team Ageing Well in Tameside Stalybridge, Dukinfield and Mossley Primary Care Network: Complex Care Team NWAS Community Paramedic Quarter 2 Adoption stage 4: Test/implement Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 1: Knowledge
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership Trafford Community Enhanced Care Service Community Paramedics NWAS GP Washway Road Medical Centre Connecting with Mental Health Later Life Presenting at Primary Care Network Clinical Directors meeting date to be confirmed Connecting with VCSE e.g. Age UK Supported discharge team e.g. Allied Health Practitioners Enhanced Health in Care Homes group Quarter 1 Adoption stage 7: Sustained Adoption stage 4: Test/implement Adoption stage 3: Decision Adoption stage 2: Interest Trafford Quarter 2 Adoption stage 7: Sustained Adoption stage 5: Adoption Community Enhanced Care Service Community Paramedics NWAS in Trafford GP Washway Road Medical Centre. Piloting with Care Homes supported by GP practice Adoption stage 3: Decision Adoption stage 3: Decision Memory Assessment Treatment Service Adoption stage 2: Interest Adoption stage 3: Decision Community Mental Health Teams for older adults Adoption stage 2: Interest Adoption stage 3: Decision Dementia Crisis Prevention Team in care homes Adoption stage 2: Interest Presenting at Primary Care Network Clinical Directors meeting date to be confirmed Adoption stage 2: Interest Adoption stage 1: Knowledge Adoption stage 2: Interest Adoption stage 2: Interest Adoption stage 2: Interest Age UK Trafford Supported discharge team e.g. Allied Health Practitioners Enhanced Health in Care Homes group
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership Wigan Quarter 2 Adoption stage 3: Decision Adoption stage 2: Interest Community React Team Wigan Lewy Body Society Commissioners (Mental Health, Commissioning Transformation) and Senior Public Health, Service Manager Population Health Community Assessment Unit Adoption stage 2: Interest Adoption stage 1: Knowledge
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership GMEC PATIENT SAFETY NETWORK, HEALTH INNOVATION MANCHESTER
GM COMMUNITY DELIRIUM TOOLKIT LOCALITY-LED ADOPTION Dementia United Greater Manchester Health and Social Care Partnership IMPLEMENTATION OF THE COMMUNITY DELIRIUM TOOLKIT POST PILOT What is the offer from Dementia United to support implementation? Project Manager s time; with delirium as part of portfolio of work with support of Dementia United governance with clinical advisor support from Dr Emma Vardy Offer of support for a locality/team Dementia United hosts a Greater Manchester wide Community Delirium Drop-In monthly session Dementia United supports a locality based meeting to aid adoption E.g. will link in with other teams in a locality, Dementia Locality Lead, GP Dementia Lead Commissioning and developing resources Translated delirium public facing information in to ten languages (audio/written resources); developing a community facilitators pack to support wide engagement/raising awareness Train the trainer sessions to be developed and delivered for all community/primary care; scoping these out with clinicians who have been involved in the pilot Hospital Toolkit resource developed and added on to Dementia United website Raising awareness Raising awareness and presenting at Greater Manchester forums and making connections - Presenting at regional, national and international conferences/webinars Seeking to publish in academic journal Working with University of Manchester: proposed qualitative service evaluation with pilot teams
