1. Dementia self-assessment Salisbury Hospital March 2012

2. 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?

3. 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.

4. 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.

5. 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.

6. 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.

7. Observational tool

9. 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.

10. 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.

11. 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.

12. Respecting and caring for people with dementia

13. Meeting nutritional needs

14. Respecting and caring for people with dementia

15. The ward environment

16. 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.

17. PROBLEMACTIONBy whomBy when Information 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 Huxter Sharon Such In 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 HuxterDecember 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 HuxterMarch 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 Staff Box 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 HuxterMONTHLY 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

18. Thank you