Content uploaded by Sian White
Author content
All content in this area was uploaded by Sian White on Feb 25, 2015
Content may be subject to copyright.
Getting on with Life – Rehabilitation & Chronic Illness in old age
Title: Top 5 – Engaging carers in person centred care for people with
confusion and / or communication difficulties
Author: Sian Keane PhD
Organisation: NSCCAHS
Position: Manager, Carer Support (Central Coast)
Contact details: Carer Support, Beane Street, PO Box 361, Gosford
2250 ph: (02) 4320 5556 or 0405 539 536;
email: skeane@nsccahs.health.nsw.gov.au
www.nsccahs.health.nsw.gov.au/carersupport/cc/centralcoast.shtml
The hospital experience is challenging for many, however it is more so
for people with disabling conditions such as dementia, stroke,
Parkinson’s disease, sensory impairment and communication difficulties.
Top 5, a collaborative practice innovation, was developed in acute-care to
address individual needs through carer identification and engagement.
Although the innovation was initiated in acute-care Top 5 processes are
transferable across settings and is currently being implemented in
rehabilitation and community sectors.
Prior to the project, data sourced from carer stories showed carers were
frustrated with healthcare experiences as their knowledge of the person
they care for was often overlooked or discounted by staff. Many carers
advised when their expertise was sought it was not recorded and
effectively communicated to others, escalating their aggravation and
increasing the disorientation and distress for the patient. Although staff
cited carer knowledge as important to person-centred care the processes
to identify carers, record and share their advice was not available. Hence
the notion of Top 5 was conceived.
So what is TOP 5? – it is a simple evidence based concept with four
MUST HAVE components they are:
1. The carer MUST be identified – staff cannot assume that every
visitor or family member is a carer – the carer is the one who
provides ongoing & sustained care to another they hold the expert
personal knowledge & history we need for developing the Top 5
list.
2. The staff MUST believe that carers do in fact hold the expertise –
if not the process will not work.
3. The staff MUST negotiate and discuss the TOP 5 personal aspects
of the person – their likes, dislikes, fears, mode of communication,
obsessions, history, their losses. There will be at least five personal
aspects to be listed (the TOP 5) – some may not be possible in the
context of a hospital setting so this must be negotiated & discussed
with the carer. It is no use accepting from the carer something that
cannot be done – eg. Showering before each meal.
4. The TOP 5 is written down on the FRONT PAGE of the bed chart
and to alert all staff of their presence a TOP 5 sticker is placed on
the name chart behind the bed.
And that is it – identify the carer, talk to them, obtain five pieces of
personal information on the person with confusion, write it down and
share it with all staff caring for the person – SIMPLE.
Staff using Top 5 reported improvement in the wellbeing and recovery of
patients, an enhanced view of carer input and a positive increase in their
comfort and confidence communicating with inpatients with confusion.
Carer satisfaction data revealed increased staff awareness of their role
(59% to 93%) and the processes assisted staff in seeking and recording
their advice (53% to 77%). “This is a wonderful project, after all, it is
always a positive to know how our loved ones are feeling and coping in a
changed environment.” (Carer)