Jo James, Lead Nurse Dementia, Royal Free Hospital

Background

The Royal Free is an acute general and specialist hospital in central London with approximately 700 beds.

The aim of our project is to develop our services and our staff in the Royal Free in order to become a dementia friendly acute hospital. We want to have a staff group who are trained and have a good understanding of the needs of a person with dementia.

However, at the core of our approach is the concept that understanding dementia needs to be everybody’s business - not simply clinical staff. Therefore we are attempting to provide training and guidelines for all the staff a patient with dementia might encounter on their hospital journey, including domestics, porters, reception staff chaplains and volunteers. We also aim to provide resources and infrastructure to support this.

Aim

• Improved patient and carer satisfaction (measured by monthly follow up calls).
• A high percentage of the entire workforce trained. 
• Improved environment for people with dementia.
• Improved well-being scores (aggregate score collected from a monthly medical/nursing notes audit).
• Reduced Length of Stay (collected monthly).
• Reduced long Length of stay (collected monthly).

What did you do?

Training has been given to 720 members of staff since April 2010. This includes the following regular sessions:

• full day nurse training  session
• specialist volunteer training
• general volunteer training
• facilities management staff training
• transport staff training
• chaplains training
• regular training for junior doctors
• quarterly multi-disciplinary team ethics workshops
• a session on the nurse induction
• pain recognition in dementia course to be commenced in January.

Resources and quality initiatives

The following are included in these initiatives.

• Use of Carer’s Passports to encourage families and carers to spend as much time as they can with the patient and to have as much flexibility as they need.
• Trust dementia portal – extensive printable information available online for staff including 10 point guides and delirium guidance.
• Trust dementia standards.
• supporting paper resources on the wards.
• Use of eight Important Things About Me to personalise care in the acute setting.
• Complementary therapies available for all patients with dementia. This service is delivered by a team who have been trained in dementia care and can support people with dementia through procedures and when they are in pain.
• Environmental changes such as large face yellow clocks, clear signage and orientation sign in bays. Also the use of coloured glasses to facilitate drinking.
• Collaboration with our neighbouring trusts and shared education.

What changed?

All our measurements show that outcomes for patients with dementia have improved since the project started. Feedback from the training has been universally positive, in particular the non-clinical workforce have responded very well to training. Since the project commenced, there has been an increase in interest in dementia and requests to provide training also.

Carer satisfaction measured with Picker-style questions has increased from 40 per cent to 60 per cent and the length of stay has reduced by an average of three days per patients and long length of stay has reduced by four per cent. The wellbeing audit results have also improved. We have noticed a significant reduction in use of sedation in this patient group.

The referrals to and use of the complementary therapy team has increased dramatically (from 89 to 960 referrals – an increase by more than a factor of 10). This indicates how understanding has changed – dementia care in hospital is beginning to be seen as a collaboration between staff, carers and therapists who can all contribute to the person’s well-being and recovery in different ways.

Advice for others

The main resource for the Royal Free has been to fund a dedicated post in order to deliver the project. The training and most of the resourcing has been done by the funded post.

However, I feel that having a small budget for dementia is vital for a dementia lead in order to buy simple things such as cups and signs.

We have tried hard to collaborate with our nearest neighbours and have developed strong links and consensus on key issues such as training. I think it’s vital for neighbouring trusts to pool ideas and share training resources. Collaborating has been nothing but beneficial for us.

For further information please contact Jo James at jo.james1@nhs.net

See other examples at Dementia - best practice examples.