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Kingston Hospital NHS Trust

Kingston Hospital is a district general hospital based approximately 12 miles from central London. The hospital supports some 320,000 people in the surrounding area including Kingston, Richmond, Roehampton, Putney and East Elmbridge. The Dr Foster 2009 Hospital Guide rated Kingston Hospital as the leading district general hospital in London and 15th in the country. We have approximately 520 beds and directly employ some 2,750 staff with another 300 staff employed by contractors but working on behalf of the Trust. We are located on one site in Kingston upon Thames. We provide a full range of diagnostic and treatment services and have a national reputation for innovative developments in healthcare, particularly in 'patient-focused' care across our services including emergency, day surgery and maternity services. Staff are committed to providing quality healthcare, working hard to ensure that we build up a wide range of clinical services.

Updated:
4 June 2014
Location:
South West
Sectors:
Medical, Hospitality, Health, Care, Hospitals and Hospital Trusts
Local Alliances:
London Borough of Richmond upon Thames Dementia Action Alliance, Merton Dementia Action Alliance, Kingston 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?

Kingston Hospital’s We Care About People With Dementia initiative aims to improve the hospital outcomes and experiences of patients with dementia and their families.  We use our 5-point plan, taken from the DAA and NHS Institute for Innovation and Improvement, called ‘Making SPACE for good dementia care,’ to structure our action points. It emphasizes staff education, person-centred care, partnership with carers, early detection and diagnosis, and optimisation of the physical environment.

Our culture of caring, safety and responsibility, at all levels - from our Trust Board and Executive Management Team, to ward staff, students, and domestic staff - will support and sustain our improvements in dementia care and ensure that we achieve our objectives to create a dementia friendly hospital.  Actions are driven by our Delirium and Dementia (DaD) Team, a multidisciplinary team of highly motivated staff who share experience, passion, leadership, and drive to improve care; it has successfully implemented significant and lasting positive changes.

We are involved in whole systems collaborative dementia work with Clinical Commissioning Groups (five), primary care, mental health trusts (two), community providers (five), social care, voluntary agencies and care homes. We recently successfully completed a joint dementia research project with St. George’s hospital.

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

Acute hospitals are not designed to provide person-centred relationship-based individualised care. Our biggest challenge is to embed a permanent change in knowledge, awareness, attitudes, culture and behaviour so that people with dementia become our most important group of patients, ones who are discussed at staff, management and educational meetings throughout the hospital:

  • From ‘Board to ward’ – raising awareness so that all staff know about the needs of people with dementia and really care about the impact of their behaviour on patients and carers.
  • Improving our standards of care to the level where all staff are knowledgeable and are proud of the person-centred care that we provide
  • Beyond Kingston Hospital – using our whole systems collaboration to work with our main Clinical Commissioning Groups to improve dementia knowledge, awareness, change behaviour and develop joint systems to provide excellent dementia care within and after discharge from hospital.

2. Actions

  • S = Staff who are skilled and have time to care (workforce)

    • Mandatory ‘basic dementia awareness’ for all staff, at induction - review
    • Enhanced a) dementia and b) delirium training for all staff involved in the care of older people – review and start new round of annual training
    • Develop, implement and deliver training for domestic staff, porters and ward receptionists; engage dementia champions from these staff groups
    • Engage junior doctors – junior doctor champions to promote dementia awareness events and to recruit more dementia champions
    • Develop more dementia champions – and promotional material such as badges, pens, stickers, posters
    • Educate executive management team and Trust Board (and Governors)
    • Implement a volunteer dementia programme to support health care staff in tasks such as safe feeding, engaging patients with dementia in meaningful activities and mobilisation on the wards.
    • Provide graduate students with an opportunity to receive dementia training, conduct research in the area of dementia care, and assist with care of patients with dementia
    • Engage medical students in dementia awareness training, CQUIN audits (early detection and diagnosis) and providing high quality dementia care.
    Status:
    Initial Scoping

    Update - FIrst Quarter

    N/A

    Update - Second Quarter

    N/A

    Update - Third Quarter

    Nothing to report - new DAA member

  • P = Partnership-working with carers

    • Further development and implementation hospital-wide of the ‘Forget-me-not’ scheme of identification of people with dementia
    • Utilise ‘Carer’s passport’ and parking pass programme hospital-wide to encourage and support patient carer presence and assistance with care of patients with dementia
    • Further implementation hospital-wide of the ‘8 Important things about me’ to promote individualised person-centred care
    • Provide carers with appropriate information about dementia and where to access more relevant information/education
    • Provide carers with tools and information to assist them in navigating the health care system and accessing appropriate services
    • Develop robust discharge planning taking into account the needs of each person’s carer, as well as the person’s needs: to ‘go home safely with partnership working’
    • Assessment and reporting of patients’ and carers’ experience of care (National CQUIN 2013/14)
    Status:
    Initial Scoping

    Update - First Quarter

    N/A

    Update - Second Quarter

    N/A

    Update - Third Quarter

    Nothing to report - new DAA member

  • A = Assessment and early identification of dementia

    • National CQUIN 2012/2013 and 2013/2014: continued use of national screening question and brief validated memory assessment, followed by the Dementia and Delirium Diagnostic Assessment for those patients with cognitive impairment (without diagnoses of dementia or delirium). Continue monthly audits to assess performance. (> 90% achieved Q3 2012/13).
    • Gather feedback from Community Mental Health Teams for Older People (we work with 7) to gain insight into how our increased rates of detection has impacted on their referral rates and their service
    • Ask newly diagnosed/suspected new diagnosis patients and carers how they feel about the diagnosis

     

    Status:
    Initial Scoping

    Update - First Quarter

    N/A

    Update - Second Quarter

    N/A

    Update - Third Quarter

    Nothing to report - new DAA member

  • C = Care plans – person-centred and individualised

    • Use the ‘8 important things about me’ at the bedside to ensure individualised care
    • Ask patients and their carers to fill in the ‘This is Me’ document and share contents with the staff
    • Each person with dementia to be medically reviewed every day using the ‘frail elderly’ person’s checklist (also called the ‘Caldwell ward round’ checklist) to provide comprehensive medical review and reduce/prevent the onset of delirium
    • Timely and robust discharge planning, in conjunction with each person’s carer(s) and/or family
    Status:
    Initial Scoping

    Update - First Quarter

    N/A

    Update - Second Quarter

    N/A

    Update - Third Quarter

    Nothing to report - new DAA member

  • E = Environments – dementia-friendly environments

    • Bid submitted for capital funds from the Department of Health to improve the physical environment, according to guidance from the Kings Fund ‘Enhancing the Healing Environment’
    • If successful, to install  memory rooms in our Emergency Department and in our Single Acute Assessment Unit, install 6 day rooms for older adult patients with cognitive impairments, use appropriate colour in wards, contrastive colour toilet seats and grab rails, install large clocks and signage to support patients with visual sensory impairments, promote orientation and reduce stress, install coloured handrails on ward walls to promote safe mobility and auditory systems to support those with auditory impairments.
    • Further development/implementation of plans for colour contrastive crockery to enhance oral food and fluid intake
    • Planned reconfiguration and integration of our assessment units and ambulatory care centre, giving us an unprecedented opportunity to ensure that this area is dementia-friendly
    • Planned reconfiguration of inpatient medical beds to ensure a dedicated older person’s specialist unit: the Elderly Care Model, where frail elderly people are looked after by specialist staff trained and experienced in optimising their care and communicating with their relatives.
    Status:
    Initial Scoping

    Update - First Quarter

    N/A

    Update - Second Quarter

    N/A

    Update - Third Quarter

    Nothing to report - new DAA member