Sue Wood, Sister, Taunton and Somerset NHS Foundation Trust

Background

Somerset has a predominantly older population and predictions for 2018 suggest that 50 per cent of over 65 year olds will have a dementia. The number of patients admitted to Musgrove Park Hospital with an acute medical problem and who also have dementia has increased and will continue to increase year on year with an associated cost to the trust.

The Trust was successful in being accepted onto the Department of Health and King’s Fund Enhancing the Healing Environment National Programme this year with the focus on improving the care environment for people with dementia. We were awarded £50,000 to use on the project.

The project focused on Sedgemoor Ward which is an acute elderly care ward and at any one time 3/4 of our patients have some form of cognitive impairment.

Aims

The aim of the project was to provide an environment for cognitive-impaired patients that is easier to comprehend and navigate. This can make it easier for them to settle in hospital, thus reducing their stress and dependence on hospital staff.

Objectives

  1. To reduce the impact of an acute hospital admission for a person with dementia by providing a safe dementia friendly ward environment which promotes and retains a person’s function and daily living skills. 
  2. To reduce the level of anxiety of a person with dementia and the possible behaviour issues which can become evident, facilitating the medical needs of the person to be addressed more effectively leading to a shorter hospital admission and a return to their normal place of residence.
  3. To reduce the use and cost of antipsychotic and sedative medication use to manage challenging behaviour.   
  4. To reduce falls.   
  5. To reduce additional staffing costs for 1:1 supervision.
  6. To change the culture of staff on the ward from a ‘do for’ to a ‘do with’ approach to patients.
  7. For patients to maintain function, independence and life skills to facilitate early discharge.
  8. Provide facilities that enable relatives to have a more active, supportive role on the ward.

What did you do?

The project was supported by the King’s Fund who supported the five person team through the process. The team was project led by myself, Sue Wood (Sister on Sedgemoor Ward), with Wendy Darch (Parkinson nurse specialist), Marian Gentile (Senior Occupational Therapists) Darren Potter (estate manager) and Fran Pit (Musgrove Partner). We reviewed the latest research finding, had input from Mary Marshall from Stirling University, had feedback from staff, carers and patients on the ward and from the wider community who helped us identify the issues.

The team came up with a plan to improve the layout of the ward, to make it a more friendly and warm environment somewhere less clinical. The major aspect of this plan was to remove the nurse station at the centre of the ward and create a reception desk at the entrance.  We also wanted to improve the bathroom and toilet facilities and improve our signage again to encourage independence and to help maintain skills. We wanted to introduce more colour to aid wayfinding, improve the lighting and create quiet areas in the bays for patients to sit away from their beds.    This came at a cost and the project team successfully bid for additional capital funding from the trust to complete what turned out to be an ambitious project.

What changed?

The culture on the ward is beginning to change. Staff no longer have the nurse station to gravitate to and are back in the bays with their patients. Staff are increasingly aware of the patients’ needs and no longer work in a task orientated way. We are increasingly working with the patient and not ‘doing to’ them rather 'doing with'. Falls have not yet decreased as we were hoping but we are encouraging patients to walk around more so it is difficult to fully evaluate. We have had positive feedback from everyone who has seen the ward. Patients and their relatives and visitors are spending time away from the patients bed space.

In doing the changes we also brought in a snack trolley which is in the ward area and is available for patients and their relatives. This is often used as a destination during therapy sessions and staff are increasingly offering additional drinks and snacks to patients and their relatives. We were also donated a range of books that are being used in the seating areas with great success.

The ward was opened on the 5th October so it is a little early to have any significant data on the changes. However, since we have been open there has been no episodes of violence and aggression.

Advice for others

The ward environment has changed, and altering the culture will take time and needs consistent leadership to maintain the culture shift in the short term.

This project was expensive but elements and the principles of the environmental changes are replicable, for example the small seating areas cost approximately £1,000 and dementia clocks only cost £70.00. Some elements, for example the snack trolley are not difficult or expensive and are not hard to introduce.

For further information please contact Susan Wood at susan.wood@tst.nhs.uk

See other examples at Dementia - best practice examples.