Plenty of information and well designed bays help patients with dementia cope. Alistair Burns explains how.
The presence of dementia is not well recorded in hospital inpatients but estimates suggest that 25 per cent of NHS beds are occupied by people with the condition. There is much to be done to support people with dementia and their carers, particularly by addressing the physical environment of hospitals and training and education.
Studies suggest that effective mental health liaison services can reduce lengths of stay for people with dementia by between 2.2 and four days. A 2.2 day reduction would mean that around 1.7 million bed days could be saved by more effective management of people with the condition.
The estimated cost of a bed is £240 per day, so this reduction would save around £415m across the NHS.
Impairments in memory, reasoning and learning are all present in people with dementia and can make negotiating the way around an unfamiliar ward a real challenge. The King’s Fund’s Enhancing the Healing Environment emphasises the importance of the environment and shows that relatively inexpensiveinterventions such as changes to lighting, floor coverings and improved wayfinding can have a significant impact on patients’ wellbeing, for example by reducing falls, while improving staff morale.
The national dementia strategy was published in February 2009 with 17 objectives aimed at improving the care of people with dementia.
In September 2010, the Department of Health named the five aspects of dementia care which would be priorities over the succeeding 12 months.
These were early diagnosis,care of dementia in hospital, dementia in care homes, reduction in the use of antipsychotics and support for carers at home.
The emergency assessment unit at Royal Wolverhampton Hospitals Trust’s New Cross Hospital aimed, as part of the Enhancing the Healing Environment programme, to make the ward less intimidating and alien for patients with dementia and so reduce confusion, agitation and fear.
A review of the care pathway indicated that over 70 per cent of those admitted through the accident and emergency unit spent some time in the EAU. The majority of patients are elderly and many have dementia.
Following consultation it was decided to remove the large, busy, confusing and cluttered central nurses’ station which dominated the area outside the bed bays and create an open reception desk. It was also decided to refurbish and redecorate two of the six bed bays to aid recognition and also to improve toilet signage.
Large images of different flowers placed behind each bed enable patients to find their way back much more easily. Nurses, doctors, therapists and pharmacists now write their notes seated at the small “pods” in each bay. This has had the added advantage of making staff more visible to patients and there has been a marked reduction in the use of the nurse call system. Additional lighting has been installed outside the toilets and large clear signs have been placed on each door.
The scheme opened at the end of May 2011. Since then security calls have fallen month on month and there were 16 patient falls in quarter 1 of 2011, down from 63 in the same period in 2010. Patients and visitors have been very complimentary and 87 per cent of staff say that the changes have affected their job satisfaction positively.
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Workforce education key to improvement
Care of people with dementia in hospital is an important, yet regularly neglected, element of acute hospital work. The benefits for individuals in terms of quality of care and patient experience and the organisation in terms of quality of clinical service and cost savings are palpable if dementia care is carried out well – getting it right for dementia means getting it right for all older patients.
Training is the key to many successful initiatives in dementia care. The rates of training for hospital staff are low and the Alzheimer’s Society reports that 52 per cent of nursing staff have not been exposed to any work-based training in dementia.
If 25 per cent of patients in NHS beds have dementia then why is there no mandatory training for the condition? It seems a plausible aspiration for 10 per cent of NHS staff to be dementia expert, 50 per cent dementia skilled, and 100 per cent dementia aware.
There are a number of resources available to support quality care. Person centred care is an important guiding principle. Life Story Network and the Alzheimer’s Society pamphlet This Is Me can provide essential background information to a person with dementia.
The Royal College of Nursing has published a “commitment to the care of people in general hospitals” and core principles include: staff to be informed, carers to be involved in care, a dementia assessment to be carried out, care planning to be person centred and responsive, and environments to be dementia friendly.
Common core principles for supporting people with dementia
- Know the early signs of dementia
- Early diagnosis of dementia helps people receive information, support and treatment at the earliest possible stage
- Communicate sensitively to support meaningful interaction
- Promote independence and encourage activity
- Recognise the signs of distress resulting from confusion and respond by diffusing a person’s anxiety and supporting their understanding of the events they experience
- Ensure family members and other carers are valued, respected and supported just like those they care for and are helped to gain access to dementia care advice
- Managers need to take responsibility to ensure members of their team are trained and well supported to meet the needs of people with dementia
- Work as part of a multi-agency team to support the person with dementia
Source: Skills for Health, Skills for Care, Department of Health
Three things an HR manager could do about dementia:
- Check how many members of staff have knowledge of the care competencies of dementia and have an awareness raising session with the trust board
- Identify the dementia lead in the hospital to develop an action plan for staff training. If there is not a lead officer to take up the position.
- Put details of the main dementia websites on the payslips of everyone in the trust for the next three months
Three things an estates manager could do about dementia:
- Identify the dementia lead in your hospital and go for coffee to talk about the environment and how it could be made more dementia friendly. If there is no dementia lead, offer to take up the position
- Work with a couple of people with dementia and their carers and walk around the wards to see how they could be improved.
- Familiarise yourself with the Enhancing the Healing Environment initiative