A View from the Bedside. Getting it Right for Vulnerable Patients

Ms E ChildsDirector of Nursing and GovernanceExecutive Lead for Safeguarding Adults

Dr G. KendallConsultant Care of the ElderlyClinical Lead for Dementia

About Us• Medium sized District General Hospital with

world class aspirations. Positive benchmarked performance

• Work positively with partners – Torbay and South Devon NHS Trust, Local Authorities, 3rd Sector

We Serve• Diverse area, coastal and moor = 300+sq miles• Large % of older people, 23% over 65 and

highest number of over 85’s• Significant deprivation in many parts of local

population

Our Key Priorities: Safest care, No Delay, Best Patient Experience

Continuing to improve safety, reducing overall

hospital mortality

Eliminating unnecessary

waits for patients in all

aspects of their care

Aspiring to achieve a

‘positive and ??’ experience for

all parents / carers

Improving quality through

greater partnership

working CQUIN Scheme 2010/11

Dementia - Improving Care at the BedsideWho:-

Executive Lead:Director of Nursing

linking into local Safeguarding Adults Board

Executive Lead:Director of Nursing

linking into local Safeguarding Adults Board

Operational Lead: Associate Director of Nursingmember of Torbay Learning Disability

Partnership Board

Medical Champion: Consultant Physician

Care of the Elderly

Clinical Nurse SpecialistDementia Care

Mental Capacity Act/Safeguarding Adults post

Supported by increasing ‘dementia champions’

Dementia – Improving Care at the Bedside What have we implemented?

• Board to Ward awareness – patient stories told ahead of each meeting• Dementia Policy – underpinned by principles which include minimizing

ward moves. • Use of ‘forget me not’ symbol (flagging PAS)• Development of local ‘dementia champions’ underpinned with

education / coaching• Embedding patient profiles for dementia and learning disabilities (similar

to ‘this is me’).• Mealtime companions (Wards) Dementia befriender (A&E)• Laminated card – prompts for staff – fits into ID badge holder• Observations of care• Multi disciplinary ‘Board Rounds’

Dementia - Improving Care at the Bedside

• Observations of care – replacing ‘real time’ patient feedback questionnaires

oWeekly processo Trained staff (all disciplines) and external – presently

Foundation Trust member ‘Working With Us Panel’• Immediate feedback to staff observed in delivery of care• Record then filed with actions for evidence (CQC)• 30 minutes observation

oWhat do I see?oWhat do I hear?oWhat do I smell?oWhat do I feel?

Dementia – Improving Care at the Bedside

• Each patient discussed – ‘forget me not’ icon for dementia / special needs

• Outcomes – daily update on care plan, involvement of carer, improved communication, speedier discharge home/transfer increasingly nurse led

• Multidisciplinary Board Rounds• Swift Plus – Interactive White Board

(Linked to PAS)• Led by consultant• Involving – Junior Medical Staff, Ward

Nursing Staff, OT, Physio, Discharge Co-ordinator, EoL Co-ordinator

Dementia – Improving Care at the Bedside

• Safety• risk factors• Ill patients• Infection control issues

• Improved Communication• Whole team involvement• Plan updated daily

• Discharge Planning• Day 1• Destination and EDD• Paperwork• Nurse led Discharge

Dementia – Improving Care at the BedsideThe Board Round – Benefits:-

Dementia – Improving Care at the Bedside

Dementia – Improving Care at the BedsideThe Board Round – Pros and Cons

- Daily - MDT - Improved communication - Training - Safety - Drives discharge planning

- Time - Timing - Confidentiality - Attendance

Motto – “if we get it right for patients with Dementia – we get it right for everyone!”

Thank you!