Lancashire Teaching Hospitals NHS Foundation Trust

As a provider of acute care to the population of Preston, Chorley and surrounding areas Lancashire Teaching Hospital NHS Foundation Trust has a key role in delivering better outcomes for people with dementia and their carers

Updated:
27 November 2014
Location:
North West
Sectors:
Health, Medical, Care, Hospitals and Hospital Trusts
Local Alliances:
Lancashire Dementia Action Alliance, Untitled

1. Action Plan

1. The National Dementia Declaration lists a number of outcomes thatwe 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 provider of acute care to the population of Preston, Chorley and surrounding areas Lancashire Teaching Hospital NHS Foundation Trust has a key role in delivering better outcomes for people with dementia and their carers. It is vital that we reduce any unwanted effects of hospitalisation for patients with dementia by ensuring that we have a caring workforce who understand the needs of patients living with dementia, and that we have a suitable environment and appropriate equipment to assist patients and their carers to maintain as much physical and mental function and routine normality as possible.

Lancashire Teaching Hospitals NHS Foundation Trust has been working with our community health and social care providers our third sector, and commissioning partners to develop the whole health economy approach to improving outcomes for patients with dementia.

We are already providing monthly Dementia Study days, incorporating dementia awareness training into induction and preceptorship programmes.  Our last Nursing and Midwifery Professional Update Day focussed upon caring for patients with dementia and showcased some of the trust initiatives. We have held nursing curriculum discussions with our local HEI to encourage the inclusion of dementia as a theme to run through every aspect of the curriculum.

We have created and implemented dementia specific documentation that helps us to understand the needs of each individual patient (‘forget me not’)

We will be working towards embedding the ‘forget me not’ documentation throughout the trust.

Lancashire Teaching Hospitals has a developing research capability and an established partnership with Lancashire Care for the delivery of clinical trials to dementia patients. 

A number of staff from different disciplines have already been trained through the Kings Fund programme, and work has commenced on upgrading ward and waiting area environments to increase their suitability for patients with dementia.

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

The challenges faced by Lancashire Teaching Hospitals NHS Foundation Trust are similar to those faced by most acute care providers. Patients admitted to hospital as emergencies are acutely unwell; those admitted as elective patients usually go through a period of feeling unwell due to surgery or invasive procedures but increasingly the number of patients needing very special and thoughtful care in relation to their underlying conditions such as dementia has required a different way of looking at acute care.  The challenge is to ensure that the care of patients with dementia is integrated into everyday activities with the acute trust.  This requires more time, and more resources than with traditional care of acutely unwell patients and consequently these are probably the biggest challenges for us especially when put into the context of the capacity pressures, reduced funding, increasing acuity and dependency of all hospitalised patients within an NHS that has struggled to keep pace with these and many other changes.

2. Actions

  • Developing a caring workforce who understand the needs of patients living with dementia

    We are already providing monthly Dementia Study days, incorporating dementia awareness training into induction and preceptorship programmes.  Our last Nursing and Midwifery Professional Update Day focussed upon caring for patients with dementia and showcased some of the trust initiatives. We have held nursing curriculum discussions with our local HEI to encourage the inclusion of dementia as a theme to run through every aspect of the curriculum.

    Status:
    Delivery

    2014 - Second Quarter Update

    To date over 1000  staff have been trained in Dementia Awareness. The training is delivered in a multi-modal format, mixing classroom learning with e-learning and workbooks also 'shop floor' learning - to ensure that the training fully supports and enhances staff's ability to understand and support those living with dementia whilst attending hospital. Fifty percent of staff who have undertaken specific dementia awareness training are in non-clinical roles, which supports the organisation working towards a dementia friendly environment in all services and departments.

    We also have a growing programme of Dementia Champions - the aim of which is to have at least one champion in every department and service throughout the hospital. We have developed Dementia News - a newsletter and also badges to support our champions in their roles and ensure that they are easily identifiable to colleagues and members of the public as sources of help and advice.

    Update - First Quarter 2013

    Nothing to report - new DAA member

    Update - Second Quarter 2013

    N/A

    Update - Third Quarter 2013

    We have developed a challenging training needs analysis to ensure that we have sufficient staff of all disciplines to support our aim of becoming the best Dementia Friendly Hospital. Training programmes for all staff (not just clinical), are now well established. We are utilising both locally developed classroom sessions as well as participating in a national programme of self-directed study (NCFE Certificate in the Principles of Dementia Care). In addition, ward based sessions are being provided to staff who provide Enhanced Care to ensure that every patient's needs are managed and responded to in a compassionate, caring and most appropriate way.

    We have also developed a Dementia Champion Programme, inviting all staff to join and become a source of knowledge and expertise within their own work areas. We have 'Champions' from across the organisation  including portering and domestic staff. 

  • Safe and appropriate individualised care

    We have created and implemented dementia specific documentation that helps us to understand the needs of each individual patient (‘forget me not’).

    We will be working towards embedding the ‘forget me not’ documentation throughout the trust.

    We will also be expanding upon the ‘forget me not’ concept to develop dementia champions identified by an ‘earned’ ‘forget me not’ badge and also a dementia friendly award for ward areas meeting dementia related criteria.

    Status:
    Delivery

    2014 - Second Quarter Update

    The forget-me-not documentation is currently being reviewed and updated to ensure it continues to meet the needs of patients, carers and staff, then a programme for increasing its use throughout the hospital will be implemented.

    A new pain assessment tool has been developed and implemented across the Trust to assist those with cognitive impairment (such as people living with dementia) to have their pain relief needs accurately identified and addressed.

    Regular themed tea parties are being held on a number of elderly wards to promote hydration, nutrition, social stimulus and engagement, involving the multi-disciplinary team, patients and their carers and friends. They are proving very popular!

    Update - First Quarter 2013

    Nothing to report - new DAA member

    Update - Second Quarter 2013

    N/A

    Update - Third Quarter 2013

    We continue to embed the 'forget me not' documentation across the Trust, and by focusing on the needs of individual patients we are expanding and enhancing our 'activity bags' for Dementia patients to complent the delivery of our enhanced care.

    We have started to produce our own activity blankets 'in-house.' Our linen department have been very willing and enthusiastic partners! The blankets have gone home with some of our patients and the feedback has been excellent. 

  • Continuous Improvement

    We have registered 6 or our wards for the Quality Mark for Elderly Friendly Wards with the Royal College of psychiatrists.  We will be working towards achieving this within the next 12 months – it is not exclusively for dementia patients but all of the standards within the Quality Mark will enhance the environment and the ability of our staff to care for patients with dementia.

    Status:
    Completed

    2014 - Second Quarter Update

    In July 2014, five wards were successfully awarded the RCPsych Quality Mark for Elder Friendly ward status - there are only 11 other wards in the country who have achieved this award. We are currently exploring the possibility of other wards applying as those wards who have been involved in the process have found enormous benefit for both themselves as teams but also for their patients (as evidenced by the improved scores between phase I and phase II) .

    Update - First Quarter 2013

    Nothing to report - new DAA member

    Update - Second Quarter 2013

    N/A

    Update - Third Quarter 2013

    All 6 wards successfully achieved stage 1 and are now working through their action plans to achieve stage 2 (data collection will commence February 2014)..

    Action plans cover a variety of areas including nutrition (we have developed picture menus, improved access to adaptive cutlery); staff training (inclusion of the multi-disciplinary team and development of enhanced care sessions); and ensuring use of appropriate pain assessment tools.

  • Involving partners

    We will continue to work closely with our partner organisations to improve outcomes for patients with dementia.

    Status:
    Delivery

    2014 - Second Quarter Update

    The RVS have recruited their first dementia volunteers and they have joined the ward teams to provide company and engagement for patients and their carers.

    We have invited a number of community partners in to present to our Older People's Steering Group - and as a result, have been able to engage them in our progrmme of work - one example is our local AGE UK working with our Emergency Department to explore how to  provide timely home support to the elderly following an emergency visit to the  hospital. Age Concern Lancashire is also promoting their services in the hospital during visiting times to raise awareness of their local services.

    Update - First Quarter 2013

    Nothing to report - new DAA member

    Update - Second Quarter 2013

    N/A

    Update - Third Quarter 2013

    We have engaged with our local council (Preston City Council) to promote best practice and shared learning.

    We are working with the Royal Voluntary Service on a 2 year volunteer programme to provide additional voluntary support within 4 specific wards. A range of evaluation criteria have been developed to determine the impact of this approach. The scheme is due to commence in January 2014. Volunteers are currently being recruited.

    We have developed an ongoing programme of public consultation events, involving patients', carers and related local organisations including Age Concern and local care homes. These consultations have centred on what we do well and what we can improve and have centred on issues such as: hospital design; communication, and nutrition.

  • Developing research partnerships

    Lancashire Teaching Hospitals has a developing research capability and an established partnership with Lancashire Care for the delivery of clinical trials to dementia patients.  This was put in place in 2012 and currently supports a randomised controlled Phase IIb trial in Alzheimers.  The partnership enables both Trusts to offer treatment trials to dementia patients which had not been possible before.  We are planning that within the next 12 months further partnerships with local HEI’s will increase our involvement in dementia related research.

    Status:

    Update - First Quarter

    Nothing to report - new DAA member

    Update - Second Quarter

    N/A

    Update - Third Quarter

    N/A

  • Providing the right environment

    We have already upgraded one of our medical elderly wards to make the environment friendlier for patients with Dementia. We are planning to role these environment improvements out across the whole organisation. We are bidding for DoH monies to support this initially.

    Status:

    Update - First Quarter 2013

    Nothing to report - new DAA member

    Update - Second Quarter 2013

    N/A

    Update - Third Quarter 2013

    A successful Department of Health bid has enabled us to embark on a significant programme of ward refurbishment. Five wards are having both structural and cosmetic redesign to enhance them as dementia friendly environments. This includes the use of bold contrasting colours, improved lighting, clearer signage, aids to orientation, and the creation of social spaces.