Mark Griffiths, a Dementia Pharmacist, discusses a typical day working in the Intermediate Care service

 

08:00 - Most mornings you’ll find me catching up with Jennifer, a Dementia Nurse, who I work closely with in order to provide care for Service Users with dementia within the Intermediate Care service. We often have an informal discussion about Service Users we have received referrals for, discussing whether they would benefit from an internal referral to both of us.

09:00 – Around mid-morning, I usually plan for today’s medication review home visits. I aim to conduct visits in the morning for Service Users with dementia, as often the symptoms of dementia can worsen throughout the day (This is known as sundowning). Due to only working two days a week in Intermediate Care, it is important to plan my diary accurately, so I know which Service Users I will be seeing and other tasks that need actioning. Our service covers the entire city so, inevitably, visits can be cancelled or Service Users may be admitted to hospital. Without this crucial planning every morning, I could end up driving 40 minutes to a Service User’s home to realise they are not there (This has happened before and I have soon learnt from my mistakes!)

10:00 – Time for home visits to review medication in a Service Users’ own environment.

We receive referrals to support medication compliance. This means how someone takes their medication (for example taking too much or not enough) which may prohibit them from being fully independent in all aspects of their daily life. Making some adjustments (i.e. changing the frequency of medication administration or stopping medication that is not needed or beneficial) may help increase their independence.

Referrals can be of a more clinical nature too and include initiating or reviewing pain relief. This can be a challenge as accurate history taking can be difficult from someone who has dementia. A strategy to overcome this is to discuss history with the family, neighbours, friends and other healthcare professionals or social care staff to confirm their history.

A new and challenging skill I have developed whilst working here is following up on cognitive assessments, (e.g. the Montreal Cognitive Assessment (MOCA) or Mini-Assessed Clinical Encounter (Mini-ACE)). These assessments provide a picture of the service user’s dementia and level of cognitive impairment i.e. if the assessment picks up that they are not orientated to space or time then this suggests that having medication four times a day may not be practical for this service user.

Describe your job in a tweet (140 characters) - My Job = Medication/Compliance reviews, consultation, issues, solutions, GP on the phone, on hold on the phone, actions, happy service user.

13:00 - After home visits (and most importantly – after lunch), I am usually involved in case noting the visit and providing any recommendations to the social care team, family, Service User or GP. A great improvement within Intermediate Care is being able to access Service Users’ GP records; this has made ways of working more efficient and allows information sharing more easily.

14:00 - There is a weekly review of the Service Users within Intermediate Care. The social care team will discuss progress towards Service Users’ goals and Healthcare and Specialist staff will provide their input relating to their health and social care needs. I receive referrals from peer discussion with colleagues within the team consisting of a Dementia Nurse, Dementia Occupational Therapist, senior RWs and team leaders. They all come together to share their different viewpoints of the Service Users’ support and care needs.

16:00 - Dependent on caseload, I may have a planned afternoon visit, or I use this time to catch up on emails and administrative tasks. For example today, I spent the afternoon reviewing the Intermediate Care Medication policy ready for a meeting on Thursday.

18:00 – Home Time!

Service Users’ with dementia are individuals within Intermediate Care who can have complex health and social care needs. This can sometimes make the job a challenge but without doubt, I thoroughly enjoy my job and often come away feeling I have made a real difference!