Chelsea and Westminster Hospital NHS Foundation Trust
We are an acute hospital trust, serving our local and surroundings communities.
- 11 December 2019
- Care, Health, Hospitals and Hospital Trusts, Medical, Emergency Services Sector
- Local Alliances:
- Royal Borough of Kensington & Chelsea 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?
As a hospital we are working on improving our environment. We have 1 dementia friendly ward environment and have also begun the process of replacing flooring and signage throughout the hopsital. We are dedicated to educating both our clinical and non clinical staff in dementia awareness and plan to develop further training porgrammes tailored to professionals needs. The dementia case manager is currently working with staff from both the Royal Marsden Hospital and Royal Brompton hospital to develop a training programme aimed at members of staff form the 3 organisations. Dementia case manager will continue to find ways to engage carers in changes and improvements for our dementia patients using the service. We have also introduced the 'This is me' tool as a pilot on our elderly care ward, we hope to find that this encourages carer involvement and effective communication between porfessionals, subsequently improving the experience for both the patient and their carer.
2. What are the challenges to delivering these outcomes from the perspective of your organisation?
Challenges so far have been; meeting room space to deliver the 1 day dementia training more frequently than once a month, fincancially supporting the necessary environmental changes, finding carers who have time to meet and discuss changes throughout the trust, reaching all memebers of staff to promote dementia awareness and finding/developing an audit tool to measure the impact of the training sessions.
Ensure all our patients have access to high-quality end-of-life care
An essential part of the care we offer is providing all our patients with a dignified death. The Gold Standards Framework (GSF) states person-centred care—advanced care planning can improve the experience of a person who can no longer articulate their wishes. It is crucial to recognise when a person with dementia enters the final weeks and days of their life and to respond with support that avoids unnecessary interventions and reflects the wishes of the individual and their family.
To achieve this, we will:
Commit to achieving 100% of early identification of those in the advanced stages of dementia using the GSFCommit to considering and discussing advanced care planning with the patientEducate all staff to use the GSF to identify those either nearing the end of life or at end-stage dementiaEnsure all our inpatient wards have clear information regarding the GSF available to our patients.Work together with the palliative care team to raise awareness regarding end-of-life dementia care across all our services
Develop and improve our existing environments to be more dementia-friendly
We recognise that appropriately designed surroundings can reduce confusion and distress in people with dementia. We are committed to providing care to our patients in a dementia-friendly environment at our hospitals. To achieve this, we will:
Audit existing ward areas using the King’s Fund ‘Is your ward dementia-friendly?’ environmental assessment tool Adapt existing areas to promote more dementia-friendly environments, including improved signage All new buildings and redevelopments across our sites will always be assessed to ensure that they meet dementia-friendly standards based on the King’s Fund Healing Environment Design Work with our charity CW+ to bring new innovations to our environments
Work in close partnership with our local communities
Providing care for a person diagnosed with dementia requires a whole-system approach. We are committed to working with our local partners to improve the experience for a person with dementia while they are in hospital and to provide information for ongoing support once they have been discharged.
We are committed to working with the local Dementia Action Alliance groups to contribute to the development of dementia-friendly communities for our patients
We will work in collaboration with our stakeholders to improve the lives of people living with dementia in our communities
Develop a workforce with right knowledge, skills and attitudes to provide high-quality care to patients with a diagnosis of dementiaThe National Institute for Clinical Excellence says that staff caring for people with dementia should be trained in understanding a person’s identity as an individual and their life story To achieve this, we will: • Provide knowledge and skills to staff in line with the national dementia training standards framework • Support research and development to improve outcomes for patients with a diagnosis of dementia and their families • Identify dementia lead(s) in all clinical areas across the Trust • Commit to training non clinical staff (including security, porters and receptionists) as dementia friends to support patients across our hospitals • Enable staff to learn what it’s like to live with a diagnosis of dementia and how better to support a person when they are visiting our hospital • Commit to inviting members of the local community to these sessions as part of building dementia-friendly communities
Provide an evidenced-based dementia care pathway
We aim to ensure that patients with a diagnosis of dementia, memory problems or delirium are identified on admission or at outpatient and preassessment appointments so that the service meets their individual needs and can provide the right care, at the right time, in the right place.
To achieve this, we will:
Develop a delirium assessment pathway with non-medical interventions for nursing care when a person is experiencing an episode of deliriumWe will review the dementia pathway and ensure that it links with the delirium, stroke and fractured neck of femur pathwaysAlign the dementia screening process across our hospital sitesEnsure screening results are included and sent to the patent’s GP or directly refer the patient to the appropriate memory clinic on discharge summaries
- Being implemented
2019 - Third Quarter Update
A delirium pathway has been developed, the next step will be implementation.
The dementia pathway will be reviewed by members of specialist teams to ensure alignment with delirium, stroke and fractured neck of femur pathways.
We have recently implemented a new elctronic patient record at Chelsea and Westminster hospital, this will be launched at our other site, West Middlesex hospital in early 2020, this will align our screening process across both sites.
Screening outcomes and recommendations are included as part of discharge summaries on our new electronic patient record, enabling us to share results with our community partners.
Provide high-quality, person-centred care
Person-centred care is a philosophy of care built around the needs of the individual. Central to the philosophy is knowledge of an individual and their uniqueness and preferences for living. Through person-centred care, staff can better provide care in ways that reduce distress to the individual and anticipate a person’s needs, resulting in a reduction of distress behaviours such as violence and aggression and contributing to their overall wellbeing.
To achieve this, we will:
Collaborate with our patients and their families to design individualised plans of careProvide person-centred care using a ‘this is me’ initiative to support a person’s with a diagnosis of dementia’s individual preferencesProvide appropriate stimulation and aim to reduce boredom for our patients in collaboration with our hospital charity CW+ to provide participatory arts activities, including painting, music, theatre, dance, pottery, sensory arts and spoken wordReduce the number of moves a patient with a diagnosis of dementia will experience while in hospital to promote coherence and care, and reduce the distress a move around the hospital can causeProvide open visiting on all wards and a carers’ passport supported by John’s Campaign, a provision of extended visiting rights for family carers of patients with dementia in hospitals in the United KingdomWork with our catering provider to ensure access to dementia-friendly menus with finger food options to promote nutrition for people with a diagnosis of dementia
- Being implemented
2019 - Third Quarter Update
We are educating and encouraging ward staff to work in partnership with patients and their carers when planning care. Promoting the use of 'This is me' for patients experiencing mmory problems, we have recently piloted an all about me bed board, this is above the patient bed space and provides at a glance information about patient preferencs and level of function. This will be evaluated and considered to be rolled out trust wide.
We have participatory activities provided by our charity CW+, we also have a weekly reminiscence session led by our older adults case manager. Equipment has been purchased for all wards across both sites including sensory equipment, puzzles, aquapaints, fidget tools, colouring pencils, playing cards, dominoes, bingo, games compendiums etc.
As a trust we are signed up to johns campaign and provide carers passes on the wards for open visiting. There is still some work to be done in this area, but we continue to promote open visiting to support patients living with dementia.
We do have exisiting finger food menu options at Chelsea and Westminster and on some wards at West Middlesex. We are working with our catering department to align this provision across both sites.
Offer high-quality patient and carer information and supportThere are an estimated 30 million informal carers for people with a diagnosis of dementia worldwide. Caregivers of people with dementia are critical to the quality of life of a person with a diagnosis of dementia. The effects of being an informal carer can lead to social isolation, psychological health problems and financial hardship. It is our aim to support the families and friends of our patients to improve their health and wellbeing and positively affect the quality of life of a person living with dementia. To achieve this, we will: • Ensure our carer engagement follows the principles of Carers UK and the triangle of care for dementia • Signposting and onward referral to local services for on going support • Ensure all clinical areas have easy access to dementia carer leaflets and dementia information resources
2019 - Third Quarter UpdateWe are currently working on patient facing leaflets that are specific to the boroughs we serve as well as providing generic leaflets from organisations such as Alzheimer's society, Age UK and open age. We have our first Older adults forum in January 2020, the forum is open to service users 65 years and over and carers of older adults, this will enable us to develop our current services with input from our local communities and service users.