Dementia Services within North Cumbria
University Hospitals NHS
The story so far
Acute Care
• Assessment takes place on Emergency Assessment
Unit (EAU)
• Patients transferred to Jenkin Ward/Elm B
• Care planning takes place utilising
Confusion/Delirium pathways of care
• Patient and family involvement using “This is me”
booklet from Alzheimer's society
• Referral to specialist mental health teams for
assessment
Staff Training
• Mandatory E-learning dementia training
• Local training sessions delivered via Liaison
Specialist Practitioner
• Person Centred training delivered by
University of Bradford 2011 across the Trust
• Nutritional Screening delivered by Dieticians
to ward areas and Medical staff
Environment
• Safety of secure doors within the ward environment
• Use of coloured toilet seats
• Picture signs to aid orientation within the wards. Use
of orientation boards to inform patients of
day/date/season
• Ward based therapy sessions to aid in rehabilitation
• Use of Zone working to ensure visibility of nursing
staff and improve patient observation
Best Practice Dementia care - The Future
Leadership
• Empowering local leadership and commitment
• Board level ownership. Implementation of Cumbria
dementia strategy
• Clinical leads identified:
Consultant-Dr George
Matron Nursing Standards-Andrea Tomlinson
• Identification of Champions within ward areas
Nursing Review
Leadership /Effective workforce:
• Matrons Nursing Standards, Patient
Experience and Infection Prevention
• Review of skill mix and ward establishments
• Benchmarking
• Sister/Charge Nurse - dedicated time
• Training need analysis for all staff
• Training log/records for all staff
CQUIN 2012/13
• All emergency admissions over the age of 75
to be screened following the CQUIN criteria
• Referral triggers
• Assess and investigate- use of integrated care
pathways, memory matters, dementia
pathway, individualised care plans
• Refer to Specialist Review
Dementia CQUIN: FAIR (Find, Assess and Investigate, Refer)
No known dementia
Diagnostic
review, if
indicated
Clinical
Diagnosis of
delirium
no
Dementia
pathway
Known dementia
3
Referral
yes
Positive
1
Has the person
been more
forgetful in the
last 12 months
to the extent
that it has
significantly
affected their
daily life?
1
Find
2
yes
Diagnostic
assessment
Inconclusive
2
no
Negative
Care as
usual
Assess and Investigate
3
Refer
Feedback
to GP
Cumbria Liaison Assessment service(CLAS)
Care in Acute Hospital
• Improved Liaison service, 7 days per week
• A newly commissioned liaison service - Cumbria
Liaison.Assessment team (WCH)consists of 1 Advanced
Practitioner ,3 band 6 practitioners specialising in
Alcohol, Older adults and Adults
• Improved links with Acute care providers
• Education of staff within the acute hospital settings
• Reduce reliance and use of anti-psychotic medication in
people with dementia
• Ensure improved recognition of dementia, with early
referral to the Liaison service
(Cumbria Dementia Strategy 2012)
Education and Training
• Staff need to be informed, skilled and have enough
time to care
• Matron Nursing Standards to undertake best practice
in Dementia Care Training 29th -30th May 2012
• Sisters/Champions to be identified on each ward
area who will undertake the best practice in
Dementia Care, training and cascade to ward staff
• Monitor compliance with Mandatory training
• Monitor Nutritional screening training
• Improved End of Life Care - Liverpool Care Pathway
Partners in Care
• Patients and carers – directly involved in care planning;
• Introduce “This is me” across the Trust
• Involvement of families/friends in assessment, care planning
and decision making
• Flexible visiting and flexible approaches to routines so that
family/carers/supporters can be involved directly in care
• Engagement with patient and family on expected length of
stay, plan of care and discharge planning
• Patient/Carer stories
• Improve Awareness of carers strategy and provision of
information. Carers information desk in Atrium at CIC to be
replicated at WCH
Environment
• All wards to undergo an assessment “Is your ward Dementia
friendly”
• Patient Flow -minimal moves to avoid unnecessary distress;
• Visible staff-zone working
• Appropriate lighting , floor coverings plus aids to support
orientation and visual stimulation,eg visual signs, large clocks,
calendars, photographs, memory boxes, use of colours,
recognisable sanitary wear
• Personalising bed space
• Adequate space and resources to support activity and
stimulation
• Availability of staff to support rehabilitation egg occupational
therapy, activity coordinators
(RCN Commitment to the care of patients with Dementia in Hospital 2011)
Prescribing
• Aim to reduce anti psychotic prescribing
• Previous audit results show that the Trust is low prescribers of
anti psychotics
• New policy for anti psychotic prescribing currently in draft
• New anti psychotic prescribing restricted to Consultant with
all benefits and Risks explained to the patient/carer
• Regular reviews of medication recommended on admission to
hospital and discharge by GP’S in order that anti psychotics
are stopped within 6 weeks
• Audit cycle
Launch Butterfly Scheme
• A successful way of sharing carer expertise
and insight with all staff who take over the
care of people with Dementia in hospital
• A practical strategy to meet the needs of the
patient with Dementia
• Delivery of effective, appropriate care,
reducing patient stress and increasing their
safety
• Staff satisfaction
Butterfly Scheme
• An opt in 3 part scheme:
1. At a glance discreet identification via a
butterfly symbol for hospital patients who
have dementia and wish staff to be aware of
it
2. All staff are trained to offer specific care;
3. The butterfly alerts all staff to the easy to
use carer sheet
Performance Assessment
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•
•
•
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CQC Assessment
Quality Indicators
Patient Stories
Patient satisfaction
Staff satisfaction
Dementia audit