A New Approach To Nursing
Home Liaison:
Lochaber Telemedicine Clinic
NHS Highland
Dr Fiona McGibbon Consultant Old Age Psychiatry
Future Challenges for Old Age Psychiatry
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Ageing population
4029 people in the Highlands with dementia, predicted to
double in 20 years
Costs of dementia care predicted to triple in 20 years.
Declining working age population – less younger people
to care for the elderly.
Abbeyfield Ballachulish
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At least 2 hours and
80 miles from
Inverness.
No Old Age CPN’s in
Lochaber
Previous input only 1
– 2 visits by a
psychiatrist per year
Abbeyfield
Ballachulish
24 care home beds
2 are intermediate
care beds
2 are respite beds
Very sheltered
housing
Day Care
Lunch Club
Old Age Psychiatry Telemedicine Clinic
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There is evidence to support using telemedicine in dementia.
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Identifying undiagnosed dementia in residential care veterans: comparing
telemedicine to in-person clinical examination.
Shores, M et al
Int. J. Geriat. Psychiatry, 19: 101–108. doi: 10.1002/gps.1029
Cognitive intervention for community dwelling older persons with
memory problems: telemedicine versus face to face treatment. Poon, P;
Hui, E; Dai, D; Kwok,T;Woo, J,
International Journal of Geriatric Psychiatry
Evidence mainly for early dementia, none for mid to later
stages of dementia.
Old Age Psychiatry Telemedicine Clinic
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Nurse led clinic.
Lead nurse – Richard O’Keeffe (Nurse Team Leader of
acute dementia assessment ward)
Twice a week for 2 hours.
Patients can be referred by GP, Psychiatrist or Abbeyfield
Staff.
Any psychiatric problem not just dementia.
Patients can be interviewed, meetings with family, discuss
cases with staff and/or GP via VC.
Supervised by Consultant Psychiatrist.
6 monthly (ish) visits to Abbeyfield (nurse and consultant)
allowing face to face reviews.
Old Age Psychiatry Telemedicine Clinic
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Patients are asked if they agree to be reviewed via
telemedicine.
Next of Kin/Power of attorney are also asked where
appropriate.
No recordings are made.
Old Age Psychiatry Telemedicine Clinic
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Focus areas
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BPSD (use of Forth Valley BPSD guidelines)
Antipsychotic monitoring - using the 3 T’s approach (Royal
College of Psychiatrist Guidelines)
Depression
In the first 3 months
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10 patients involved in the clinic
All had a diagnosis of dementia
Most commonly referred with behavioural and psychiatric
symptoms of dementia (BPSD)
Outcomes
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2 patients successfully withdrawn from
antipsychotic medication.
2 patients managed solely with behavioural plans.
No new prescriptions for antipsychotics
2 prevented admissions
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Difficult to calculate a cost saving but average stay
in our dementia assessment unit is 10 weeks and
cost of admission to New Craigs is £290/day.
Potential savings of £40600.
One patient was admitted
Outcomes
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3 patients were able to complete questionnaire
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All were satisfied with the clinic, felt comfortable and listened
to, all were happy to have further consultations in this manner
and did not want to wait longer or travel further for a face to
face appointment.
9 staff questionnaires
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All very positive. All feel there knowledge and confidence has
improved, all were comfortable with communicating via VC
and felt residents managed VC as well.
“Communication flowed easily between client and VC Nurse”
“Very beneficial and informative”
“Great way to communicate”
Example case
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86 yr old lady, severe dementia.
Two recent admissions to hospital with challenging
behaviour that staff felt unable to manage.
Recurrence of same symptoms
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Mainly during interventions (scratching, kicking, biting, shouting)
At times requiring 3 staff to assist
Poor compliance with medication
One occasion so agitated she refused interview via VC
and attempted to push VC unit over.
Example case
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However, discussing her with staff and putting in place various
behavioural techniques (validation/distraction/minimising
stimulation) staff confidence improved as did her behaviour
and compliance with medication.
Contact information for staff to arrange violence and
aggression training given.
No additional medication was prescribed.
Admission was avoided (similar symptoms resulted in
admission previously).
Developed an infection in the setting of late stage dementia,
reviewed by GP for palliative care and died peacefully in her
local area close to her family instead of 80 miles away in a
dementia ward.
Future Plans
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Roll out to two other care homes in the Lochaber area in
progress
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MacIntosh Centre Mallaig
Invernevis House Fort William