Aims and objectives(a) Describe the co‐development of a point‐of‐care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital.BackgroundStrategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations.DesignThree‐stage, mixed‐methods, process and outcome evaluation.MethodsThe App was co‐developed with experts, nurse end‐users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist.ResultsThe App included three components: cognition and risk assessment; tailored evidence‐based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device‐related factors.ConclusionsThe App provided an evidence‐based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation.Relevance to clinical practiceCo‐development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real‐time access to assessment tools and tailored knowledge supported nurses' clinical decision‐making; workload and unfamiliarity were barriers to use.

There is increasing recognition that integrated services provide improved quality and cost-effective care ( Ham, 2011 ; Ham and Curry, 2011 ; Goodwin et al, 2012 ). This article outlines the steps taken to create an integrated care pathway for people living with Parkinson's, a process that could be transferred to benefit those living with other neurological conditions. The impetus for this work followed increasing national interest in how services delivered by multiple service providers and professionals could be improved, and financial efficiency gained, while also optimising quality of care for those living with Parkinson's. The project sought both to create an effective integrated care pathway benefiting those living with a given condition within a specific area and then to understand how this process could be replicated for other areas and conditions.

Background: It is possible that about 30% of all dementia is preventable by addressing many of the modifiable health and lifestyle risks important for overall physical health. Currently, people in the pre-dementia or very early dementia stage who are referred to Memory Assessment Services (MAS) in the UK receive minimal, if any, support and/or intervention. They are typically referred back to primary care until the full syndrome of dementia emerges. This represents a lost opportunity to modify the trajectory of the condition, intervene with disease modifying therapies (DMTs) when available, and delay the onset of a full dementia syndrome. Objective:We aimed to develop a blueprint for a pragmatic 'Brain Health Clinic' (BHC) that can be implemented alongside, or in conjunction with, conventional MAS.Methods: Using modified consensus methods, an interdisciplinary task force of clinicians with experience in the diagnosis and care of people with cognitive impairment and dementia, met on several occasions to review existing evidence, share clinical experience, and propose a model for a pragmatic, 'real life' BHC, as an extension of, or embedded within, a current MAS. Results:The BHC is a systems-based, integrated care approach that uses existing resources, and can be developed by reconfiguring the way current MAS are provided. It can support people with early-stage cognitive impairment to remain well for longer, potentially changing outcomes. The practical, evidencebased and user-friendly blueprint is available as a free online tool (depicted in figures throughout this article). It sets out a vision for managing early-stage cognitive decline using a 'preempt-prevent' approach that maximizes brain health and quality of life for the person at risk and their families. It sets the stage for implementation of validated, clinically useful biomarker batteries and DMT to be introduced when available, fostering personalized cognitive healthcare. Conclusion:Adapting existing services to address neurodegenerative cognitive decline in the very earliest stages is a key intervention for secondary prevention of dementia.

A recent audit to assess the progress of the National Service Framework for Long-term (neurological) Conditions has found limited progress.

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