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Cumbria leads the way in prevention and management of Delirium

Staff from Reach-out Team

A service which is the first of its kind in the UK is leading the way in screening and assessing patients to prevent delirium.

The Memory and Later Life service at Cumbria Partnership NHS Foundation Trust launched ‘Reach-Out’ (Reduce, Educate, Assess & Care with Hope) in 2018 after co-designing the service with mental health specialists, clinicians, patients and carers. The teams work seven days a week at both the Cumberland Infirmary in Carlisle and West Cumberland Hospital in Whitehaven.

David Storm, senior clinical service manager, explains: “Delirium is mental confusion, which can sometimes occur when people are unwell. It can be caused by a number of things, including infections, dehydration and pain, but with the right support it can be managed or even avoided. Reach-Out is a dedicated service for delirium and has several key elements; prevention, effective screening, support, treatment, liaising with other services to support discharge and education. “

Since its introduction, there has been a 20% reduction in positive cases of delirium reported and a reduction of 869 days in hospital. It is widely recognised that people recover quicker at home following an acute illness. The service was recently highlighted by the Care Quality Commission (CQC) in North Cumbria University Hospitals NHS Trust’s latest inspection report (November 2018) as an area of good practice.

The Reach out team promotes hydration and nutrition through supported feeding during hospital stays and optimises the patient’s ability to connect with and make sense of their environment by making sure that glasses, hearing aids are working and worn. The team also provides one-to-one support of distressed patients and works with the ward teams on the management of patients with distressed behaviour, allowing the ward staff to focus on their patient’s medical care.

A patient, who did not want to be named said: “I was not sure what was happening to me when I was in hospital as I quickly seemed to feel confused and frightened. The Reach-Out team were lovely; they spent time with me and always came back when they said they would. I felt great reassurance from their visits and looked forward to seeing their smiling faces every day. They also were able to speak to my wife and my daughter who had been very worried about me and I know this also helped them. Thank you so much I couldn’t have asked for better care in the ward and from the team.”

David Storm added: “Providing quality patient care is central to the effectiveness of the service with the team frequently going the extra mile to ensure patient’s needs are able to be met and carers were provided with information, advice and support. In addition, the services’ ability to work within an integrated approach, marrying the benefits of mental health and physical health expertise- to offer real person centred care- has been fundamental to its success.”

Comments from staff at North Cumbria University Hospitals NHS Trust include:

“The service is a very important development in the care of the elderly patient.”

“The Reach-out team provide practical assistance, advice and feedback on how best to nurse elderly patients who are delirious. They are now part of the multi-disciplinary team and help the flow of patients to enable safe, quicker discharge.”

“The team helps to stimulate the patients and notify us of any changes. They are a vital service gaining information and relaying concerns.”

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