Dementia self-assessmentSalisbury Hospital

March 2012

Introduction Spring 2011 – developed a work

programme based on 8 standards of care.

Question: How do 8 standards translate to

actual ward-based practice? How do we measure whether we

are making any improvements?

Process of self-assessment

Borrowed Dementia Charter Mark from RUH Bath.

Used this as basis for trust dementia self-assessment tool.

4 main areas of care: Respecting and caring for people

with dementia. Ward environment. Meeting nutritional needs. Suitability of staffing.

Assessment 3 main componenets: Notes audit. Utilising real-time patient feedback. Observational audit.

Also obtained information from the education centre re staff education and from the Food and Nutrition Group re feeding at mealtimes.

Notes Audit 10 main stem questions:

Screening for dementia. Length of stay. Place of origin (admitted from) and

discharge destination. Evidence of comprehensive assessment. Nutritional assessments. Carer assessments. Use of anti-psychotics. Number of ward moves. Evidence of MDT discharge planning. Mental Health referral.

Observational Tool Team of observers. 2 went to each medical and

surgical ward and some out-patient areas including ED.

Unannounced visits any time of day.

Clinical areas observed for 1 hour each.

Included environment check.

Observational tool

Observation -Outcomes Each ward was given a

qualitative report of findings within 24 hours.

Immediate feedback perceived as being useful to incite change.

Wards were very pleased with the process.

Example feedback There was no visible leaflets or any information about

dementia that could be seen or access by carers or family visiting the ward. We are aware that the dementia champion has produce a resource file on dementia with leaflets and info for carers and a separate file for staff. Unfortunately none of this information was visible on the ward.

Real time feedback was undertaken on the 5th July 2011 Areas of concerns and good practice has been sent to the ward sisters.

Meal time audit and observation was undertaken on the 10th May 2011 and the next observation will take place on the 3rd January 2012

All important area were signposted. All ward toilets were clearly signed

There were no use of colour to guide patients. Standard Clocks were available. Not every bay had a

clock. In one of the bay, the clock had stop working. During our visit we saw therapist interacting with some of

the patients,. They were spoken to in courteous and professional manner.

Data were extracted from the reports to add to overall self-assessment audit.

Later once all information gathered from 3 methods of assessing wards, all wards given a complete copy of their results re dementia care.

This exercise also generated trust wide report.

Respecting and caring for people with dementia

Q1_5 Patient / carer feedback indicates a high level of satisfaction

(from RTF - using average values for Apr-Sep)

0

1

2

3

4

5

6

1 out of 6 RTFquestions were above

or equal to median

2 out of 6 RTFquestions were above

or equal to median

3 out of 6 RTFquestions were above

or equal to median

4 out of 6 RTFquestions were above

or equal to median

5 out of 6 RTFquestions were above

or equal to median

6 out of 6 RTFquestions were above

or equal to median

number of wards

Meeting nutritional needsQ3-3, 3-4, 3-5, 3-6

01 1 1

2

4

2 0 0 0

1

0

10 12 12 12

109

0

2

4

6

8

10

12

14

Q3_3 Do staff ensure allpts are able to reachand to eat food and

drink with assistancegiven as necessary? (results from Q5 of

observational study)

Q3_4a Is thererecognition of the needto protect mealtimes?

(results from Q6 ofobservational study)

Q3_4b Are carersencouraged to visit ifthey wish to? (results

from Q6 of observationalstudy)

Q3_4c Do pts sit at atable more socially ifthey are able to, andwish to? (results fromQ6 of observational

study)

Q3_5 Is there flexibilityin provision/presentation

of food? (results fromQ7 of observational

study)

Q3_6 Are colouredtrays and crockery

used to support pts withdementia at mealtimes?

(results from Q8 ofobservational study)

yes - all

most

some

no

Respecting and caring for people with dementia

Q1_3 Do all staff talk to pts and visitors in a professional, caring and courteous manner?

(results from Q2 of the observational study)

5

8

most

yes - all

The ward environmentQ2_3 Is boredom prevented by regular therapeutic

sessions or activities for inpts? (results from Q4 of observational study)

4

31

5

no

some

most

yes - all

Did it make a difference? Results given back to wards one

month prior to peer review. All wards went to considerable effort

to improve in areas where they were weak.

All wards since completed a dementia action plan.

Repeat whole process in April / May. Of all assessment methods –

observational audit was best at instigating change.

PROBLEM ACTION By whom By whenInformation about dementia for people

visiting or attending the ward.Samples of information available to be

displayed, visitors will be actively encourage to seek out staff to access the

information, thus encouraging a dialogue to increase understanding

Angela HuxterSharon SuchIn shared corridor

November 2011

Advertise who the dementia champion is and who the other champions

are

THIS IS US information board in shared corridor. ‘Dementia champion’ now on

identification badges

Angela Huxter December 2011

Staff that were on duty had not carried out any dementia training

All staff to access the MLE training as part of appraisals

Angela Huxter March 2012

Improve understanding of the person behind the dementia

THIS IS ME paperwork to be available and completed with staff, visitors and family

Create a THIS IS ME BOX – ask family to bring in artefacts that are of significance.

All StaffBox ready and in

use.[Good reports back

from NH]

October 2011

REAL TIME FEEDBACK Senior Sister to cascade results of feedback to Dementia Champions to cascade to

others as part of ongoing training

Angela Huxter MONTHLY

Ward toilets signs Research has shown that colours have a greater significance. By painting the

door frames a bright colour e.g. yellow helps to differentiate doors to those with dementia and poor eyesight, in

discussion

To be agreed with ETS

Example Action Plan

Thank you