Mini-ACE for Cognitive Screening
The Mini-Addenbrooke’s Cognitive Examination (Mini-ACE) is the recommended cognitive impairment screening tool in New Zealand, to assist with dementia diagnosis.
The Mini-ACE replaced the Montreal Cognitive Assessment (MoCA©) test in September 2020, as New Zealand’s recommended cognitive screening test. Anyone who conducts cognitive impairment screening should be using the Mini-ACE test, unless they are willing to pay for individual training and certification through the MoCA Institute or they are using an alternate test for some reason.
Carole Kerr, dementia educator and registered nurse, says the initial changeover from 1 August last year went well. “Many practices have made the transition seamlessly and practice nurses are confident using Mini-ACE, after completing the one-hour training. The Mini-ACE is free, easy to use, takes around five minutes to complete, and online training is available on DHB and Ministry of Health learning platforms.”
The use of the Mini-ACE test is not prescriptive, but it is the recommended tool on NZ HealthPathways, for use by primary care and non-specialist dementia services. It evaluates four main cognitive areas – orientation, memory, language and visuospatial function.
Mini-ACE was identified as the most appropriate tool following a Cognitive Impairment Assessment Review last year, to find an alternative to the MoCA. The review was sponsored by the New Zealand Dementia Framework Collaborative and endorsed by the Ministry of Health and the National DHB Health of Older People Steering Group.
There are still health professionals who have not realised about the change from MoCA to Mini-ACE who need to be encouraged to use the new tool, says Carole. “We have to ensure continuity by completing the training and supporting practice nurses with Mini-ACE. It’s a very effective tool to help support a timely diagnosis and it is important that we use the same tool as much as possible.”
Stroke survivor shares story at annual study day
Andrew and Peta Buxton shared their story at the most recent South Island Stroke Study Day, held in November 2020.
When caring for stroke survivors, balancing realism with hopeful enthusiasm is important, says Andrew Buxton, who shared his personal experience with health professionals at the South Island Stroke Study Day. “Reality is good, but hope is essential.”
Andrew spoke alongside his wife Peta about their journey following his stroke, at the annual event held in Christchurch. “One day I was fit and healthy and had no known risk factors, then two days later I’m in hospital, looking at a very different future. Somewhere in the first week, I knew I had a choice – I could either give up to self-pity or turn it somehow into a positive and make the most out of anything that happened.”
In August 2018, Andrew lost the use of his left arm and leg after a stuttering, slowly progressive stroke at their home in Christchurch. Following an unsuccessful clot buster treatment, CT scans and an MRI, he was told improvement wasn’t expected and the loss could be permanent. “That was very hard to hear. You’ve got to keep a bit of hope there or that’s where there could be an entry for depression.”
Andrew felt there was also some room for improvement with the transition from hospital to home. “After being discharged, I felt very much on my own. There was a delay in community services. Some form of therapy and physio needs to be offered straight away. We were lucky because we are well resourced, but not everyone is.”
Andrew’s engineering background, positive ‘can-do’ attitude and problem-solving skills have been useful during his rehabilitation. He can now walk and has also partially regained the use of his left arm. He joined other community groups and has ‘Exercise as Medicine’ sessions with a personal trainer, and now has a specially designed and built ‘recumbent trike’ (very fast!) to maintain his fitness.
After initially looking at a possibly bleak future, he can now cycle with Peta, drive, go camping, and play golf with one hand. “Relying on others to get around was a pain, and I really wanted to drive my truck again. So, I went through rigorous testing and passed my licence. It was wonderful to be independent with wheels again.”
The role of positivity is ‘everything’ during rehabilitation, says Peta. “Andrew is an optimist. This helped him stay positive and push himself. I’ve had profound moments of sadness watching him at times, but it’s important not to give in to self-pity, to keep perspective, and to be grateful for what you still have.”
During Andrew’s stay at Burwood Hospital, he wrote the words Normalise and Conquer on the whiteboard at the end of his bed. “In other words, accept the new normal and get on with life,” he says. “How did that work for me? Pretty well. I achieved a lot. Not everything I wanted to though. I had to compromise on some things. I can still go fly fishing, but I need to use a specially-designed chest harness.”
Andrew’s inspirational story exemplified what one of the key note speakers of the day, Southern DHB physiotherapist Dan Harvey, spoke about – encouraging independence in rehabilitation and increasing practice outside of therapy.
Dr Carl Hanger, Geriatrician and Stroke Physician at Burwood Hospital in Christchurch and Clinical Senior Lecturer in medicine at the University of Otago, Christchurch, says health teams need to encourage patient practice in-between rehabilitation sessions. “Being actively involved helps to rewire the brain.”
Delivered jointly by the Stroke Foundation of New Zealand and the South Island Alliance, South Island-wide stroke service providers, stroke teams, GPs and practice nurses from across the continuum of care learnt about a wide range of stroke-specific topics on the day, including post-stroke depression and grieving, maximising communication and increasing socialisation for patients with aphasia, and optimising community rehabilitation.
Dr Hanger, who is also one of the organisers of the event, says feedback from the day has been positive. “The speakers were all excellent and one of the attendees said they have been involved with stroke service delivery/development for more than 30 years, and they still learnt so much.”
South Island Stroke Study Day November 2020
GPs and other health professionals will focus on improving the quality of care for stroke patients at the annual stroke study day in November. The event is being held in Christchurch and delivered jointly by the Stroke Foundation of New Zealand and the South Island Alliance’s stroke services team. Register for the event here…
Guest Editorial Anna Carey Chair Of The Health Of Older People Service Level Alliance
28 Oct 2020
Anna Carey, Chair of the Health of Older People Service Level Alliance.
As the South Island ACP (Advance Care Plan) facilitator role – supported by the South Island Alliance – comes to an end, I thought it was timely to reflect on the progress we have made with advance care planning.
Advance care planning is one of several priorities across the South Island. With the recent COVID-19 pandemic, it has brought the need for ACPs into sharper focus both for health teams, and for a person and their whānau. International evidence has found that advance care planning leads to less unwanted aggressive medical care, better quality of life near death, decreased rates of hospital admission – especially age residential care residents – and those who have completed an advance care plan are more likely to receive care that is aligned with their wishes.
For the past few decades, ACP conversations have evolved. In the early days, there was a focus by many on the document. These days, there is better recognition of the value of the process in supporting people to understand and share values, goals and preferences regarding future medical care. Given this, the process of advance care planning is usually a series of conversations, often with whānau and different providers. People’s goals and values change to reflect changing health, and the system to support advance care planning in the South Island aims to support this.
In addition to having a digital ACP, which can be shared across the South Island for those with access to Health Connect South/HealthOne, a new South Island digital solution was developed this year – ACP Progress Note. The tool provides the option to use a dropdown box and record a targeted advance care planning conversation using the serious illness conversation guide framework, or health teams can use the free text format to record the interactions and discussions that happen during the advance care planning process.
As of September 2020, we now have 4982 ACPs on Health Connect South – 869 completed by four DHBs who commenced their digital journey on 1 May 2019. Canterbury DHB has been using the digital system for seven years and has completed 4113 so far. All these plans can be accessed across the South Island health system. Such progress has been achieved by collaboration and alliance working. Regional leadership through the Health of Older People Service Level Alliance (HOPSLA) has contributed to working in a broadly similar manner across the South Island. While there are many regional projects to complete, these are on hold, awaiting resource.
Meanwhile, the more we can support people who live in the South Island to have these conversations, document them if they wish and share them electronically on Health Connect South/HealthOne, the more we’re able to be truly person-centred in our approach.
South Island Stroke Study Day Enhancing Practice And Care
05 Oct 2020
Attendees at a previous South Island Stroke Study Day
Health professionals will focus on improving quality of care for stroke patients at the annual stroke study day on 10 November 2020. The event is being held in Christchurch and delivered jointly by the Stroke Foundation of New Zealand and the South Island Alliance’s stroke services team.
South Island-wide stroke services providers, stroke teams, GPs and practice nurses from across the continuum of care will learn about a wide range of stroke-specific topics, including post-stroke depression and grieving, maximising communication and increasing socialisation for patients with aphasia, as well as strategies for a smooth transition from hospital to home.
The strong line-up of multi-disciplinary speakers are from nursing, speech-language therapy, physiotherapy, social work and occupational therapy. One of the key note speakers is Dan Harvey, a physiotherapist from Southern DHB, who will talk about encouraging independence in rehabilitation and increasing practice outside of therapy.
Dr Carl Hanger, Geriatrician and Stroke Physician at Burwood Hospital in Christchurch and Clinical Senior Lecturer in medicine at the University of Otago, Christchurch, is part of the team organising the event. He says health teams need to encourage patient practice, not only during their rehabilitation sessions, but in-between. “Being actively involved helps to rewire the brain.”
Another keynote speaker, Dr Chris Collins, Canterbury DHB Psychiatrist for Old Age, will cover grieving and depression after a stroke – at what point does it become abnormal? He will also discuss apathy and tiredness vs post-stroke depression.
Social worker Tracy Norman will speak about preparing for the transition from hospital to home, which will cover preparing carers for their role, changing roles within the family unit, ensuring realism vs maintaining optimism, and taking care of yourself. Dr Hanger says many people who experience a stroke struggle with the transition from hospital to home. “Getting it right is essential.”
Andrew Buxton is this year’s consumer, who will speak about his post-stroke experience and journey to recovery. Dr Hanger says the speaker line-up this year is impressive. “I’m really looking forward to listening to all of the presentations. The South Island Stroke Study Day is a great opportunity for health professionals who are wanting to learn more, share ideas and upskill themselves.”
Attendees can join the event via video conference if there is a key contact for their local group who can take registrations and support the local running of the Study Day.
More information and register
Electronic Acp Solution Live Across The Region
09 Sep 2020
A digital solution designed to capture conversations around Advance Care Planning (ACP) has gone live across the South Island.
The ACP Progress Note provides a single, regional solution for clinicians to document and access important discussions with patients about their future health care planning and end-of-life wishes.
Canterbury Initiative ACP Facilitator Jane Goodwin says it’s a consistent way for clinicians to log those conversations, which can then be electronically shared securely. “Advance care planning conversations don’t always lead to a person creating or completing an ACPlan. So, the ACP Progress Note allows clinicians to document discussions in a consistent location that can be accessed by other health care staff across the sector.”
Canterbury DHB initially had a locally-developed version of electronic progress notes. The improved South Island version enables health care professionals using HealthOne and Health Connect South to record or document ACP conversation with the patient.
Conversations about what’s important to a person and their priorities for care if they become unwell are even more important in the current environment – especially if a person has underlying medical conditions, Jane says. “For example, a man with terminal melanoma was referred to our team for support to create his ACPlan. We used the ACP Progress Note to capture our phone conversations ahead of the home visit.
“Unfortunately, a couple of days before that appointment, he had a significant stroke and could no longer communicate his wishes. Discussions with his whānau and the information captured in the ACP Progress Note helped the medical team ensure his care aligned with his preferences.”
The ACP Progress Note was fast-tracked during the pandemic to include the newly-released national Serious Illness Conversations Guide (SICG), providing a consistent regional solution to the electronic capture of these important discussions – either as a free text electronic record or using the SICG template (embedded in ACP Progress Notes) to support the conversation. This could include discussions with critically ill patients during COVID-19 restrictions.
Helen Sawyer, Palliative Care Clinical Nurse Specialist at Southern DHB, says the tool provides a convenient way to document a conversation that couldn’t be formalised in any other way at the time. “It’s easy to use, find and read – so we can easily record discussions with our patients, that will contribute to the development of their ACPlan.”
Expression Of Interest To Join The Health Of Older People Service Level Alliance Maori Representative
We are seeking a Māori perspective on our South Island Health of Older People Service Level Alliance (HOPSLA).The position is not as a representative of all South Island Māori, but rather someone with the experience and skills, that can bring their knowledge and expertise to the table for discussion about identifying opportunities and reducing inequities for older people to live as well as they can close to where they live.
HOPSLA brings together doctors, registered nurses, allied health as well as planners and funders who work across community, primary and secondary care settings. A Māori voice will bring a whānau ora perspective to our planning to ensure it considers the needs of kaumatua.
The role involves a monthly meeting, which alternates between an all-day meeting in Christchurch and a two-hour teleconference.
Apart from meetings there would be a maximum of three hours a month. Each year, we develop a strategic plan that is based on a three-year long-term plan. Our current plan focuses on dementia and delirium, advance care planning, and restorative model of care.
If a member’s involvement is incorporated as part of their usual job, then they will be paid by their employer as usual. If they are self-employed or not working, then they will be reimbursed for time and travel as well as any expenses.
Q: I’m interested, but not sure that I have the skills to work across an organisation that covers the whole South Island. Is it worth me applying?
A: Yes, we are keen to hear from anyone who is passionate about the health of older people and has good links with community providers and services. We are looking for someone who can plan and think strategically and communicate ideas with a wide range of people.
Complete the Application Form
Attach supporting letter from you manager (if required)
Send to firstname.lastname@example.org
Closing Date: 15 February 2020
Outcome notification: By 21 February 2020
Applications will be viewed by HOPSLA members and nominations submitted to Alliance Leadership
Team for approval. Any further questions, please contact Dr Val Fletcher, chair HOPSLA email@example.com
Stroke Survivor Shares Story At Annual Study Day
From left: Darryn Williamson, Canterbury DHB Geriatrician Dr Carl Hanger and South Island Alliance Stroke Workstream Facilitator Jane Large.
Stroke survivor Darryn Williamson shared his story with health professionals from across the South Island at the annual Stroke Study Day in October.
Almost 170 stroke service providers, including general practitioners and practice nurses, listened as Darryn spoke about his experience through the health system and his journey to recovery.
Emphasising the importance of communication and truly listening to the patient, Darryn was a very active person before his stroke in May 2018. He was on 13 boards, including the Canterbury DHB Consumer Council. “It’s very frustrating not being able to do what you used to do – when you have a stroke, you lose a lot more than your dignity.”
Darryn’s journey has taken over a year to get back to independent living. He talked about his experience and took questions from the audience, encouraging understanding and learning from a patient’s perspective. He says clear communication with the patient and between health professionals is crucial. “It’s about finding out who your patient is first, by talking to them, not just reading what’s been written about them from a folder. Really listening to the patient is so important – setting rehab goals and involving them with everything – asking them, what do they need to get over this hurdle or reach this next step towards their recovery?”
Nicola Kayes, Director of Person Centred Research Associate Professor of Rehabilitation School of Clinical Sciences, Auckland University.
The strong speaker line-up also included two researchers, one of which was Nicola Kayes, Director of Person Centred Research Associate Professor of Rehabilitation School of Clinical Sciences, Auckland University, whose research is about goal setting.
In her presentation, Nicola explained that SMART goals have minimal evidence supporting their use in rehabilitation. She presented an alternative goal-setting framework (MAP: Meaning, Anchor, Plan), making rehabilitation plans tailored to the person. It reinforced Darryn’s message of listening to the patient and asking what they want. This framework fits with any chronic condition/rehabilitation type goal.
Jointly hosted by the Stroke Foundation of New Zealand and the South Island Alliance Stroke Workstream, 170 people attended, with more than 100 joining by video conference. Held at the Rolleston Lecture Theatre at Christchurch Hospital, the event is focused on helping service providers enhance their day-to-day practice.
This year, the range of stroke-specific topics included dysphagia management, sexuality after stroke, and the implementation of telestroke in the South Island.Attendees also had a chance to ask questions about anything to do with stroke care, answered by Dr Suzanne Busch, Lead Stroke Physician, Nelson Marlborough DHB, and Dr Carl Hanger, geriatrician and stroke physician at Burwood Hospital.
Dr Hanger was one of the event organisers and says the day was a great success. “Our speakers were fantastic, and we really appreciated Darryn for his courage and honesty in sharing his experience both in and out of hospital following his stroke. It’s really beneficial for us as health professionals to hear a consumer’s perspective first-hand.”
Improving Emergency Outcomes At Aged Care Facilities
South Island Alliance’s Elizabeth Lear of the Aged Care Monitoring Service, Barry Simpson, Emergency Planning Coordinator, and Team Leader Matthew Wood.
A new online emergency training course for staff at aged residential care facilities aims to improve outcomes for residents during emergencies.
The course, Coordinated Incident Management System (CIMS) for Aged Residential Care (ARC) facilities, was developed by the South Island Alliance after a need for emergency training within aged residential care was identified following regional trial evacuations.
To increase awareness of incident management in ARC facilities, the South Island Alliance’s Emergency Planning Coordinator Barry Simpson and Elizabeth Lear of the Aged Care Monitoring Service provided a number of scenario-based training workshops for service providers around the South Island.
“During the trial evacuations, we noticed an obvious gap in emergency training for ARC facilities – especially since there is often a constant high turnover of staff in this area,” says Barry. “So, we decided an e-learning tool would be a far more efficient and cost-effective way of reaching larger audiences and to meet the needs of the vast number of rural and geographically spread providers.”
The module is based on teaching key aspects of emergency planning using CIMS, as well as business continuity planning. CIMS is used by all government agencies and also many non-government organisations. The course, designed with a focus on staff who speak English as a second language, provides an introduction and overview of the CIMS structure and process.
The course is available through online learning platform healthLearn and also includes useful resources and an interactive quiz. “We hope to enhance outcomes for residents at aged care facilities across the South Island, through helping staff prepare for emergency situations and utilising consistent protocols and guidelines across sectors and service providers.”
Online Interrai Training Now Available
interRAI Services have launched online training for health professionals who would like to read their clients’ interRAI assessments and anyone who would like to learn more about how interRAI works.
interRAI assessments are comprehensive clinical assessments, which focus on a person’s function. It is the primary assessment instrument in aged residential care and home and community services for older people in New Zealand.
The course is the first eLearning offering for interRAI users in New Zealand. It was developed to meet the growing demand from health professionals who use interRAI information to gain a better understanding of their clients’ functional abilities.
Users learn about: