University Hospitals of North Midlands NHS Trust

The University Hospitals of North Midlands NHS Trust manages two hospital sites: Royal Stoke in the city and the County hospital in Stafford. We provide healthcare including, emergency, acute and planned care to residents throughout Stoke, Staffordshire and beyond.

Updated:
12 October 2016
Location:
West Midlands
Sectors:
Medical, Health, Care, Hospitals and Hospital Trusts
Local Alliances:
Staffordshire and Stoke-on-Trent Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

The Trust has an established multi-disciplinary Dementia Working Group that meets to consider all aspects of practice relating to the care of people living with dementia who access Trust services. Through the Trust Dementia Strategy, Pathway and Framework we aim to support earlier diagnosis of dementia, the management and care of people with dementia  from admission to discharge or end of life, and the support of carers

People living with dementia access the full range of services offered by the Trust, therefore the work regarding improvements related to dementia care needs to be embedded across the organisation and beyond, to include both health and social care, thus enabling an effective and comprehensive pathway.

March 2016

The Trust is engaging with John’s Campaign, initially with a selected number of wards prior to full launch at the Nursing conference in April.

There have also been a number of Registered Mental Health Nurses employed who will work with the Mental Health Development Nurse to implement the Mental Health agenda across the Trust and also assist in further development of good dementia care.

Work is underway to develop e dementia care toolkit for use across all clinical areas.

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

Ensuring that Dementia care remains a priority in an organisation with many competing priorities both internally and externally, not least due to the complexity of patients accessing Trust services.

The trust must continue to make “reasonable adjustments” for people living with dementia and their carers, such as environmental changes, clear advice, support and information together with high standards of care. This will be achieved through appropriately trained and highly skilled staff in sufficient numbers and skill mix to afford the time and support required for this group of patients

There is a need to ensure that the focus is on patient-centered care

March 2016

We are progressing with dementia awareness training and addressing the HEE mandate of 80% of patient facing staff being trained to this level by year end, though release of staff to attend training remains an issue given winter pressures and increased workload. Work is taking place to implement a dementia training plan to ensure that staff are trained to a level appropriate to their role.

2. Actions

  • Reducing the detrimental effect of hospital admission for patients with dementia, delirium and depression through strategies to reduce length of stay, and on-going considerations to the hospital environment

    A dementia toolkit is being developed which will hold all dementia related information for both patients, carers and staff. This will include delirium and depression.

    The implementation of the mental health agenda through the employment of R.M.N’s will include training associated with all mental health conditions, including depression.

    A national audit has been undertaken regarding the use of antipsychotics and resulting action plan developed

    As areas are refurbished, consideration is given to a suitable environment for patients with cognitive issues  and a ward at County hospital will be specifically for patients with dementia.

    Status:
    Delivery

    2016 - First Quarter Update

    • Some environmental audits, using the Kings Fund tool, have been undertaken and adaptations made where appropriate, this is an on-going action. As refurbishments are scheduled then dementia friendly environments are encouraged
    • Environmental issues are raised through dementia training
    • Projects undertaken through dementia training have resulted in the development and use of memory boxes and life story books in some areas
    • We are also looking at a system to highlight any falls / incidents that involve patients with dementia so that any learning from these can be addressed as required
    • Dementia awareness training is being delivered with the mandatory training for  safeguarding adults and sessions offered in the clinical environment where it is difficult to release staff
  • Reducing / monitoring the use of antipsychotic medication for behavioural and psychological symptoms of dementia through improved skills and knowledge gained through training and regular audit

    • An audit is currently underway at Royal Stoke hospital, regarding appropriate use of antipsychotic medication. This will be concluded by the end of September 2015. A similar audit will take place at the County hospital.
    • A checklist is available to ensure the use of antipsychotic medication is appropriate and minimised
    • The RAID team is available for advice regarding mental health issues, together with a number of R.M.N’s employed across the organisation
    • Training for staff will include mental illness and the appropriate methods of dealing with challenging behaviour
    Status:
    Delivery, Implementation

    2016 - First Quarter Update

    • A antipsychotic checklist will be included in the dementia toolkit and recommendations include a locally devised audit that will be more specifically focused on patients with dementia
    • Other information relating to mental health will be included in the toolkit
    • Work is underway to introduce dementia/mental health champions
  • The trust is keen to use Assistive Technology both within in-patient settings and to facilitate the discharge of an individual in a timely manner

    Assistive Technology is currently being used within the ward settings to assist the staff in the quality of care they deliver to patients by ensuring person centred care whilst maintaining safety and wellbeing.

    Equipment such as bed and chair sensors are used to reduce the need for 1:1 observations by giving a level of independence back to the individual and eliminating situations that may cause anxiety and agitation. This however also facilitates risk assessment and management within the discharge process allowing patients to return home with this equipment giving some level of reassurance to family and carers.

    Status:
    Delivery

    2016 - First Quarter Update

    • Systems are  being improved to identify any fall or incident relating to patients with dementia in order that themes can be identified and addressed as necessary
    • The Trust intranet will be updated to hold all related information about dementia care services within the Trust
  • To continue to monitor, maintain and improve the care for people living with dementia who access acute services, through enhancing the knowledge, skills and attitudes of the workforce

    • To ensure that the Trust dementia pathway and framework is utilised across the organisation
    • Ensure that screening and assessment of dementia is a standard part of the admission assessment for all patients aged 65 years and over
    • Ensure consistent use of the ‘butterfly’ symbol and “This is about me” document across all wards and departments
    • Ensure that the staff work in partnership with carers in the on-going care of patients with dementia
    • Contribute to the Stoke / Staffordshire dementia pathway
    • Fulfil the commitments highlighted within the Hospital Charter
    • Deliver bespoke training as requested via the varying hospital departments – work currently underway with outpatient clinics
    • Continue to deliver dementia training to meet the Health Education England mandate that 80% of patient-facing staff are to be trained in dementia awareness by 2016
    • Continue to work with the competency framework for dementia care proposed across the West Midlands
    • Continue to encourage dementia friends  across the organisation
    Status:
    Delivery, Initial Scoping, Uncompleted

    2016 - First Quarter Update

    • Continuation of the above
    • Further introduction of RMN’s to support the mental health agenda
    • Initial work with the Stoke and Staffordshire steering group to look at the possibility/ introduction of a ‘patient passport’ for people living with dementia
    • Signing up to John’s Campaign from April 2016 (current trial underway)
  • The Trust aims to improve communication relating to dementia care and the availability of information for patients, carers and staff

    • Ensure that the Trust intranet is updated with relevant information relating to dementia
    • Continue to work with the outpatient clinics to develop information packs and information boards regarding dementia, delirium etc
    • Ongoing development of dementia champion’s / dementia link nurses to act as a resource for dementia information within their clinical area
    • Continue to work across the health economy to improve dementia related care and further develop a comprehensive care pathway
    Status:
    Implementation, Uncompleted

    2016 - First Quarter Update

    • Leaflet developed for carers regarding the later stages of dementia
    • “This is about Me” updated for us across both hospitals
    • Looking at “easy to read” information for inclusion in the dementia toolkit