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St Andrew's

St Andrew’s Healthcare is a charity which prides itself on delivering specialist therapies designed to manage cognitive decline, reduce challenging behaviour and/or manage offence-related risk, to encourage positive life experiences for people with dementia and promote social inclusion and access to the community. Referrals are made nationally to the Charity because of high levels of risky and challenging behaviour which have not been easily met by local NHS provision.

Updated:
19 April 2017
Location:
East Midlands
Sectors:
Care, Health
Local Alliances:
Northamptonshire 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?

St Andrew’s neuropsychiatry service, part of St Andrew’s Northampton, is a charity which prides itself on delivering specialist therapies designed to manage cognitive decline, reduce challenging behaviour and/or manage offence-related risk, to encourage positive life experiences for people with dementia and promote social inclusion and access to the community. Referrals are made nationally to the Charity because of high levels of risky and challenging behaviour which have not been easily met by local NHS provision. We are committed to the measurement of risk through outcome data, where we demonstrated for example a 47% improvement in overt aggression between admission and current presentation in our 2010 patient cohort. New reporting technology will allow update of this audit process with greater ease. St Andrew’s was the first to be awarded the RAID® Centre of Excellence in treating extreme behaviour using a relentlessly positive approach. St Andrew’s is on the steering group for the Dementia Care Mapping™ (DCM) British standard and continues to work closely with the University of Bradford. We were the first to use DCM as a key performance indicator, as both quality of care and the quality of life of our patients are valued as central to our therapeutic approach.

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

The number one challenge that provider organisations continue to face is in securing the funding to provide the best care for individuals. The economic climate is the first hurdle, the second being which pot does the funding come from. It is essential that we continue to provide detailed information about what can be expected from the clinical teams in meeting the needs of people with dementia and in minimising risk. We share knowledge and best practice with colleagues and professionals both internally and externally. Commissioners need to understand the outcomes they can expect and that this is value for money. Patients and their relatives require information and support, and reassurance that we will work with them to achieve negotiated goals and to facilitate discharge to their place of choice when this is safe to do so. We work with local teams to ensure a smooth discharge and to prevent readmission.

2. Actions

  • 1. To continue to provide high quality evidenced based care across the charity for people with dementia that challenges mainstream services.

    An ambitious project has commenced, with the aim of creating an overarching model of the service from the minute detail of individual patient resources to the fundamental therapeutic milieu. With the aim of developing a clear identity, the project is named DAISIES - Dementia Assessment and Intervention: Striving for Innovative and Evidence-based Services. Broad work streams cover the therapeutic approach, the physical environment, safety and risk and therapeutic activity. Creative thinking led to a summarising graphic that utilises flowers to represent the four work streams, and six petals to represent the core elements of each area. Supporting stems guided by national standards underpin these flowers, and are embedded in evidence-based assessment, outcome and service evaluation.

    Status:
    Delivery

    2017 - Second Quarter Update

    The Daisies project continues to be ongoing with 4 distinct work streams -

    1) Marvellous Mealtimes - aims to improve the quality of the mealtime experience for patients making this more therapeutic and tailored to the needs of those with dementia. A strategy document for the charity is currently being developed

    2) Activity - Aims to improve levels of activity and the choice of  activities available to patients on the ward, through purchasing of dementia specific activities for patients to use and engage with. Several wards now also have specific activity co-ordinators to support this aim. There has also been development of activity boxes which are more general and some designed specifically for individual patients to personalise their care and meet their specific needs and interests.

    3) Ward Environment and personalisation of Bedrooms - there has bee significant progress on each of the dementia wards to enhance the ward environment, making it feel more homely and dementia friendly. There has also been extensive work to refurbish and repaint wards where patients have had choice over the colour of their rooms and bedroom doors.  There is good signage throughout the wards to support orientation.

    4) Clinical Outcomes Project - aims to explore appropriate outcome measures to use with our patients to monitor and understand their needs and progress.

    2015 - First Quarter Update

    In progress - new conceptualisation through DAISIES initiative

    2013 - Third Quarter Update

    In progress

    2013 - First Quarter Update

    New member

  • 2. To evidence how continual service development is embedded in constructive outcome data, reflecting reduction of risk, optimised function and positive mood and engagement levels for our patients.

    Outcomes measured at individual patient level through the CPA process, and for the service through on-going audit and key performance indicators (for example, measuring aggression using the Overt Aggression Scale – Modified for Neurorehabilitation, OAS-MNR; functional ability using the Pool Activity Level, PAL; quality of care and quality of life using Dementia Care Mapping™, DCM; and establishing a dementia-friendly environment through the Kings Fund Enhancing the Healing Environment assessment tools, EHE).

    Status:
    Delivery

    2017 - Second Quarter Update

    In progress - on going routine data collection and reporting, with the aim of disseminating group data locally and nationally.

    2014 - Fourth Quarter Update

    In progress - on going routine data collection and reporting, with the aim of disseminating group data locally and nationally.

    2013 - Fourth Quarter Update

    In progress

    2013 - Third Quarter Update

    In progress

    2013 - Second Quarter Update

    In progress

    2013 - First Quarter Update

    New member

  • 3. To enrich the therapeutic approach to working with patients living with a dementia.

    To ensure Person Centred Care (PCC) and the relentlessly positive approach to extreme behaviour (RAID®) are nurtured through effective staff supervision and training, strong external partnerships with commissioners and supportive and collaborative partnerships with relatives, and underpinned by NHS Institute for Innovation and Improvement Productive Wards.

    Status:
    Delivery

    2017 - Second Quarter Update

    Ongoing - we continue to ensure that person centred care is nurtured through staff supervision and relevant dementia and RAID Training.  The development of the positive behaviour Support (PBS) plans and This is Me documents, also support this aim.

    Dementia friends sessions continue to be delivered as needed to ensure staff across the charity have a good understanding of dementia and the needs of those experiencing dementia

     

     

  • 4. In support of the DAISIES Therapeutic Approach work stream, to ensure an awareness of dementia and what works for people with dementia (including younger people) across the whole Charity.

    The aim is to ensure a skilled workforce of staff working directly with people with dementia, with specialist training in dementia and PCC as mandatory, as well as RAID® training for treating extreme behaviour. To support the Alzheimer’s Society Dementia Friend’s initiative by providing Charity-wide Dementia Information Sessions. To promote understanding of dementia amongst commissioners and referrers about the care and treatment available for people with dementia and reinforce the message that you can live well with a dementia. Staff also have a role to play in delivering training to organisations externally.

    Status:
    Delivery

    2017 - Second Quarter Update

    Ongoing -

  • 5. To continually improve upon the dementia-friendly physical environment.

    As guided by the Kings Fund Enhancing the Healing Environment (EHE) programme, to maximise the potential of existing bricks and mortar in order to optimise orientation and create an environment that is familiar, facilitative, legible and supports way-finding. To also improve visiting facilities and provide accommodations for relatives.

    Status:
    Delivery

    2017 - Second Quarter Update

    In process - both hospital wide and as part of the DAISIES initative

  • 6. In support of the DAISIES Physical Environment work stream, to adopt the Marvellous Mealtimes Charter.

    Based on the Marvellous Mealtimes Strategy and Code of Conduct first developed by Tracy Paine in 2006, the aim is to make eating and mealtimes a pleasurable experience and a time for participation and socialising by creating the right environment. Environmental enhancers, such as art work and background music, facilitate the experience (for example cueing the person with dementia into the dining experience).

    Status:
    Delivery

    2017 - Second Quarter Update

    To support the Marvellous Mealtimes Project a strategy document is currently under completion with the aim of completion in July 2017. Following this ward based observations have been planned to support an understanding of current mealtime practises to identify areas of strength and improvements using the new strategy guidelines. Staff from all dementia wards are being sought to act as marvellous mealtimes champions to support this initiative. A template for the therapies directory which outlines how mealtimes sessions are to be delivered has been developed and aims to support staff in ensuring mealtimes are protected and therapeutic in nature.

  • 7. To deliver a clear strategy on safety and risk, including excellent physical health care.

    To foster innovative approaches to safeguarding vulnerable adults as well as treating challenging behaviour, utilising relational and procedural security, and with a focus on optimising physical health (including evidence-based falls and continence care), maintaining proactive infection control and, where needed, cultivating thoughtful end of life care.

    Status:
    Delivery

    2017 - Second Quarter Update

    This is a continuous process and remains an ongoing action

  • 8. In support of the DAISIES Safety and Risk work stream, to deliver first-rate evidenced-based end of life care where patients are to stay in our care in the longer term.

    The aim is to build on the new End of Life Strategy with related policy in order to ensure procedures are highlighted and followed, as well as new training opportunities for staff facilitated by Cynthia Spencer House. In-house and external support is also offered to staff following the death of a patient. However, end of life work remains a tricky subject for all concerned, and we continue to look for ways of better supporting the patient, their relatives and the care staff involved.

    Status:
    Delivery

    2017 - Second Quarter Update

    On going

  • 9. To maximise therapeutic activity in order to ensure the service always considers the lived experience of patients with a dementia.

    To consider the individual’s needs for cognitive stimulation, reminiscence, meaningful and functional activity, individual therapy, expert-prescribed medication and social inclusion, particularly those with advanced dementia and compromised communication.  To promote and maintain individual ethnic, cultural and spiritual identities. To work with relatives and friends in order to provide information and on-going support, and maintain external support networks.

    Status:
    Delivery

    2017 - Second Quarter Update

    Patients are reviewed on a fortnightly basis by the MDT in ward round and in CPA meetings to assess changes in presentation and need. Documents such as the PBS and This is me as highlighted previously support this and identify person centred care needs, likes, dislikes and interests which support this aim. Family networks are nurtured and maintained by all members of the MDT to ensure patients voices are heard as much as possible, particularly in cases where patients are not often able to verbalise for themselves. Use of advocacy services safeguards patients where there is no family contact.

  • 10. In support of the DAISIES Therapeutic Activity work stream, to promote cognitive stimulation and reminiscence for our patients living with a dementia.

    To build on the Reminiscence Pods™ resources already purchased, for example to create a ‘barber shop’ in order to promote participation in personal care activities and engender pride in appearance, introducing sensory stimulation and building on care bonds between staff and patients through the shared social experience of participating in meaningful 'fun' activity. To complement this with group and individualised activity resource boxes.

    Status:
    Delivery

    2017 - Second Quarter Update

    Significant progress has been made towards this project. To build on the Rempods on one ward there is now a ward pub, where happy hour sessions are run on a regular basis, there is also a barber shop where patients can go to have their hair cut. There is full wall sized art work on the wall entrance to the pub with imagery of a pub front and also one to the entrance to the dining room which has imagery of a scenic cafe to entice patients to mealtimes. Several research poster presentations have been also been completed on this work and results show improvements in patients wellbeing as a result.

  • 11. To offer free advice and consultation to referrers nationally.

    Advice offered about challenging behaviour, as well as offending related risk, in order to support the care already being given and to prevent admissions. To ensure commissioners are aware of the aims of the St Andrew’s services for dementia and the evidence of improvement that can be demonstrated for this group.

    Status:
    Delivery

    2017 - Second Quarter Update

    on going

  • 12. To push boundaries through dementia research.

    To ensure St Andrew’s is undertaking research projects with people with a dementia and/or their relatives that are nationally relevant and communicated. To keep dementia on the St Andrew’s research agenda through the Charity’s Research Network, and maintain relationships locally, such as the Dementia Friendly Community of Practice at the University of Northampton, and nationally, such as the School of Dementia Studies at the University of Bradford, Euro HD and Dendron. St Andrew’s is also in partnership with a number of universities nationally.

    Status:
    Delivery

    2017 - Second Quarter Update

    Numerous research projects and posters on the use of RAID, Rempods and the DAISIES initiative to name a few  have been developed over the past few years and these have been disseminated and shared in a  number of ways including conferences such as the Dementia Congress and RAID awards. There is a significant project currently being undertaken at St Andrews on the use of virtual reality in dementia. This is in the research development and literature review phase at present.