Barbara Schofield, Nurse Consultant for Older People, Calderdale & Huddersfield NHS Foundation Trust
Background
Training in the care of people with dementia is led by vulnerable adult champions. Nurses, doctors, technicians and therapists promote best practice across 2 hospital sites. The role also addresses safeguarding, frailty, learning disability, delirium, dignity and fundamental care. The champions promote the butterfly scheme, person centred care and risk assessment. Non clinical staff are champions too. A person centred care plan involves families and carers in care planning, and captures preferences, risks, triggers for anxiety, how to recognise pain and calm the person. A community-based patient passport ensures continuity and communication. The champions also promote compassionate, relationship based care.
Aims
The butterfly scheme, carer involvement and the person centred care plan were introduced to minimise risk and improve experience and care. For example:-
- Staff are trained in dementia care and champions support them to provide best care.
- Staff can identify people with dementia and apply the principles of care.
- Staff know to look for the care plan which will help them understand the person and respond appropriately.
- Patients and carers are asked to feedback either verbally or in writing their experience of the butterfly scheme and care.
- Formal measures should demonstrate improvement e.g. complaints, incidents, falls, nutritional standards, incidence and management of delirium.
- The dignity challenges should demonstrate positive dignity experiences.
- Improved communication and integration internally and within the local community.
What did you do?
The dementia pathway was driven through a collaborative group of the Quality Improvement Strategy. The baseline for the collaborative agenda was the national dementia strategy, the local analysis of the first national dementia audit, counting the cost and local consultation with colleagues. The collaborative includes senior, and ward and department based staff including nursing, medicine, therapies, health informatics, clinical governance, clinical audit and champions.
6 Ward areas, 3 on each hospital site were selected to test out the pathway. This included the introduction of the butterfly scheme, person centred care plan, fundamental care plan, delirium plan, assessment process and other guidance such as a pain tool. A dementia matron was appointed to in-reach from the mental health Trust and more recently a general nurse has been appointed to support this role. The pathway is now in place on all adult wards.
The training programme was introduced and a champion network leads training and monitoring of best practice.
Delirium and dementia assessment is in place on all wards and assessment areas. A delirium pathway has been introduced and this is overseen by the dementia matrons and nurse consultant.
The work is now overseen by a Dementia Board and is reported formally through a strategic action plan.
The pathway is now being extended to the community setting. This includes; opt in to the butterfly scheme, the care principles, person centred care plan, the dementia and delirium guidance and documentation, training and the champion network. A community patient passport has been developed to improve communication and integration.
The pathway has been discussed at membership council meetings and other public events where interaction and collaboration have been encouraged and acted upon. The Trust now involves people with a story to tell in training, either as a result of a complaint or a good experience. We invite comments and contribution to care planning and evaluation from relatives and carers verbally and in writing.
What changed?
The approach to care for people with dementia has changed significantly. Staff now report that they have a structure within which to work. They know how to approach people with dementia and are confident in person centred care planning and risk management.
For patients and carers the experience is more positive and compassionate. People feel involved and valued and care standards have improved. It is early days but we are starting to receive written feedback from relatives and carers of positive experience with particular reference to the butterfly scheme and staff attitude.
Implementing and spreading the pathway was labour intensive at first and sustainability was a concern. However, now the champions are leading the work engagement and sustainability is much more evident.
Benefits to the organisation are yet to be recognised but we have a dashboard in place that should capture improvement.
Advice for others
The introduction of the champion network with training at the forefront of care is undoubtedly the greatest contribution to success. Senior clinical staff, including nurse consultants, matrons, dementia and LD matron, safeguarding lead nurse, and senior therapists have small designated areas where they provide regular support and supervision for the champions.
The butterfly scheme provides a practical and easy to remember care approach that is appreciated by staff, patients and their families.
Comprehensive and clear guidance and documentation prompts and informs good practice, and the person centred care plan informs the care planning process to meet the individual needs and preferences of the patient whilst maintaining safety and dignity. Involvement of carers and relatives are central to this.
The emphasis on assessment of delirium and dementia helps staff to make appropriate decisions in regard to care and discharge planning.
For further information please contact Barbara Schofield at Barbara.schofield@cht.nhs.uk
See other examples at Dementia - best practice examples.