East Kent Hospitals University NHS Trust
- 9 February 2015
- South East
- Care, Health, Hospitals and Hospital Trusts
- Local Alliances:
- Kent Dementia Action Alliance, Ashford (Kent) Dementia Action Alliance, Thanet Dementia Action Alliance, Canterbury Dementia Action Alliance
1. Action Plan
1. The National Dementia Declaration lists a number of outcomes that we 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?
We have established a Dementia Team, comprised of a Clinical Lead (Consultant Geriatrician) with a Dementia Matron, 2 Band 6 Nurses and support from Psychiatric Liaison to steer policy for patients with dementia.
Our Dementia Strategy Team works collaboratively with Health, Mental Health and Commissioners to ensure a cohesive approach to care of individuals with dementia. We are dedicated to supporting a diagnosis of dementia in high risk individuals, using tools developed for the National CQUIN.
Our Dementia pathway encourages patient-centred care, using “This Is Me” as a point of reference. A “Confusion Pathway” poster, and reference pocket guide are provided for all staff to ensure that key areas of care are met. This focuses on dignity, safety, delirium prevention and communication.
Whilst in hospital, we aim to ensure dignity is maintained at all times. We have recruited Dementia Champions for each ward area, to promote the needs of people with dementia, and support colleagues in care delivery. They provide visible leadership on our wards, irrespective of their grade.
We are actively training all Trust staff, including pharmacy, security and chaplains, in effective communication and care of individuals with dementia.
We have developed a robust governance framework to assess outcomes for individuals with dementia. Flagging a diagnosis of dementia on PAS allows real-time tracking of at-risk individuals. We monitor LOS, readmissions, discharge destination, mortality, complaints and clinical incidents involving those with dementia. These reports will guide future strategic developments.
Our Trust is working closely with charitable organisations to ensure that our strategy is informed by their expertise.
2. What are the challenges to delivering these outcomes from theperspective of your organisation?
We are fortunate to work in a health economy where dementia is considered a priority – both within our Trust and Community partners. There are, however, ongoing challenges that we face.
Maintaining the profile of dementia in individuals where this is not the primary diagnosis (ie non-Geriatric ward environments) remains a challenge.
There is a resource shortfall in the community to provide step-down facilities for individuals recovering from acute illness, but complicated by delirium. This increases the risk of long hospital stay, and long-term care home placement.
Our infrastructure makes provision of dementia-friendly environments a challenge. Adaptations funded by the South of England Dementia Challenge Fund will assist, but it will be difficult to prove that this is of sufficient qualitative or quantitative benefit to enable roll-out to all ward areas.
Management of patients with challenging behaviour in acute ward environments.
There is no system in place to ensure that patients at risk of dementia (identified through the National CQUIN) are appropriately reviewed in the community.
Real-time tracking of patients with a diagnosis of dementia
Our IT system allows real-time tracking of patients with a diagnosis of dementia. This allows targeted intervention on relevant wards, where dementia may be relatively uncommon. We are working with all divisional leads to ensure questions pertaining to cognition are included in their documentation/Integrated Care Pathways. Our Dementia pathway is simple, and focuses on symptoms, rather than diagnosis, ensuring anyone with confusion is managed appropriately.
Working in collaboration with community partners
We work in collaboration with community partners to ensure a joined-up approach to dementia care. There is agreement that those with prolonged delirium may not have every opportunity to return home. We are assessing the number of patients who may benefit from step-down resources, to assist in development of a pilot project.
To implement environmental changes, and Dementia Buddies
Three pilot wards have been identified (a Frailty ward on each acute site) to implement environmental changes, and Dementia Buddies. Adaptations will be within current ward foot-prints. Whilst this restricts change, it should make changes reproducible in all ward areas. We are working with other Trusts in Kent, in a hope to demonstrate tangible benefit of these changes. Such changes may be difficult to detect on a ward/Trust basis.
Developing staff education sessions
We are developing staff education sessions specifically focusing on behavioural challenges, and de-escalation techniques. Tools, such as Behaviour charts, are being promoted to ensure better understanding of why behaviour may change. We are encouraging use of “This Is Me” as a guide for staff when managing patients with behavioural challenges.
Working with CCG
We are working with CCG leads to ensure that at risk individuals are on appropriate risk registers. This will flag patients for future review or assessment, and will provide the basis for future audit .