On June 9th, I was honored to present a patient case to a phenomenal group of dementia care experts as part of Project ECHO Dementia at the University of Washington Memory and Brain Wellness Center. Project ECHO is a learning model in which front-line care providers like myself from around WA State meet in a web-based virtual conference room with an interdisciplinary panel of experts in memory loss and dementia. At Rippl we feel a strong alignment with the UW Memory & Brain Wellness Center as we both strive to “promote the well-being of those living with memory loss and their families” through exceptional care.
To be honest, I was quite nervous to present to such an esteemed group! But my passion to deliver the best care possible took over as I told the story of my patient. She was diagnosed with FTD (frontotemporal dementia) and was placed in a locked Memory Care Unit in December of 2022 because her husband could no longer take care of her. Since being in the Memory Care Unit, the patient started to have a myriad of behavioral issues that included: hallucinations, seeing deceased loved ones, “mothering” other residents, intimidating other residents, agitation after family visits, escapism and medication non-compliance. She has also had 3 hospitalizations in the last 4 months. Her family is desperate to improve her quality of life and keep her out of the hospital.
After presenting my case the UW Clinicians gave high level feedback. They understood the nuances of caring for this patient population and explained the psychology behind it. They provided a comprehensive round-table preceptorship that was beneficial to my learning style. They were able to take my input, view and management of this patient and process it. They asked astute questions, then proceeded with critiques and recommendations on how to keenly look at the patient case. Just a few examples of the excellent insights shared:
- Dr. Nancy Isenberg pointed out that “mothering” is a behavior that is not part of FTD. Mothering is empathy and this is not a behavior that FTD patients typically have. She stated that this characteristic makes her question the diagnosis of FTD. The question truly is: Is this FTD or early onset Alzheimer’s disease? This was quite intriguing to me, I never thought to evaluate or question her diagnosis.
- Karen Clay, the social worker, recommended that the family members, siblings, and children of the patient undergo genetic testing due to a strong family history of Alzheimer’s and Dementia.
- Trang Le, PharmD suggested that if the patient benefited from a cholinesterase inhibitor (a common dementia therapeutic) then possibly she doesn’t have FTD.
The hour-long session flew by – it was incredible to hear directly from such a diverse
set of perspectives. I am a firm believer that this type of engagement, feedback, and interaction with experts in this field edifies clinical practice. Our collective knowledge base in this area of healthcare is constantly evolving. Having specialists to support you, teach you, and challenge you is key to improving patient care. No one has all of the answers so a learning mindset is critical. For example, this experience has altered my approach in exploring current diagnosis and verifying a diagnosis. UW Echo is a safe space to become a better practitioner. It allowed difficult self reflection and provided positive direction on how to manage high acuity patients – all in an inclusive, caring and supportive manner.
I went into the meeting feeling vulnerable and anxious but left feeling both inspired and empowered. One of our core values at Rippl is “Raising the Bar for everyone” which emphasizes our commitment to leveraging world class expertise to define a new standard of care. Partnering with the country’s leading academic institutions and geriatric clinicians, we are bringing clinical excellence to our seniors. We are so grateful to the University of Washington Memory and Brain Wellness Center for sharing this commitment and allowing us to be a part of Project ECHO Dementia.
Patrice McNeil is an Nurse Practitioner and Changemaker at Rippl
