146 Reducing distressed behaviour in cognitively vulnerable patients during hospitalisation: the role of a Health and Wellbeing Health Care Assistant (HWB-HCA)

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Abstract Background Over 40% of older people admitted to acute care experience physical and/or cognitive hospital-associated decline (HAD). People with cognitive vulnerabilities (dementia, delirium) are at particular risk of HAD due to longer hospital stays, use of psychotic medication, boredom, and separation from family. We aimed to implement and evaluate a new ‘Health and Wellbeing Health Care Assistant (HWB-HCA) role as part of a multidisciplinary older adult ward team to provide positive stimulation for cognitively vulnerable patients. Methods The HWB-HCA role was funded by the South/South-West Hospital Group. It combines elements of the standard HCA role (personal care, nutrition, mobilisation etc.) with protected time (four hours per day) for cognitive distraction activities tailored to the individual patient. Interactions start with the HWB-HCA, family and patient completing the Sunflower tool to identify personal interests, dislikes, and triggers for distressed behaviour. Individual activities at the bedside are planned and driven by the patient’s interest. The multiple methods evaluation includes audit of psychotic prescribing, observation, patient and family feedback, and staff interviews. Results To date, the HWB-HCA has delivered 130 structured sessions (72 hours) to 14 patients (median hospital stay 22 days). Activities include chatting, reading, prayers, painting, creative writing, exercise, hand massage. Patients’ reactions are overwhelmingly positive (smiling, laughing, engaged, more relaxed). The role is positively viewed by families, one testimony- ‘she is amazing, so patient, I don’t know how she does it’. Monthly point prevalence audit of PRN psychotic indicates a reduction (mean 5.5% vs 9% in the previous six-month). Lack of social space and staff shortages remain the biggest challenge to operationalising the role. Conclusion The HWB-HCA has been a positive innovation enabling a wider range of non-pharmacological activities to reduce incidents of distressed behaviour managed by psychotic prescribing.