How can we improve Dementia Care? asks Dr Chris Dyer Consultant Geriatrician and Clinical Lead Royal United Hospitals Bath NHS Foundation Trust
Dr Chris Dyer presented at todays Dementia conference on the dementia strategy group set up in 2008 to address the challenges set out in the National Dementia Strategy.
We kicked off our dementia strategy group in 2008 to address the challenges set out in the National Dementia Strategy. We started with an enthusiastic energetic team consisting of staff from various parts of the organisation and early on gained valuable input from groups such as the Alzheimer’s Society, Alzheimer Support Wiltshire and local Carers groups.
However having a dedicated group alone is not enough to achieve widespread cultural change. This truly does need to be a clinical and executive partnership – with executive support dementia became one of our key quality outcomes.
Furthermore having enough people to “do the doing” is essential – there are so many changes that need to be made e.g. sorting out the training, environmental audits and orders, awareness raising etc.. and so a matron was seconded, and we also gained input from staff at our “Qulturum” which is our centre for all those involved in quality, risk, patient experience and audit under one roof. So what are we proud of?
~ Good engagement, dementia events – a constant process
~ A 7 day per week mental health liaison service and dementia coordinators with a fund to support timely discharge which has reduced length of stay by 1.5 days so far
~ A newly refurbished “dementia friendly” ward and environmental changes
~ Volunteer befriending scheme run through the Alzheimer’s Society
At the RUH our ward charter mark is a key driver for engagement, spreading change, and boosting awareness:
We developed the Charter Mark as a way of challenging wards to improve by offering a reward for excellence, and also showing visitors what is going on. The charter mark has 17 standards. Our matron works with wards until they are ready to be assessed and then the assessment is led by members of our team with external control by the Alzheimer’s Society. There are Gold, Silver and Bronze awards – but so far no one wants bronze – we have 6 Gold and 14 silver. More recently several of our wards are also participating in the innovative Quality Mark for Elder Friendly Wards scheme run by the Royal College of Psychiatrists.
And so a continuing challenge is delivering the dementia CQUIN. Our approach is to embed this within our wider strategy and seek “buy in” from staff. Putting quality of care in the hospital as central – for example, if we can identify more patients with cognitive impairment on admission we can prevent delirium and improve clinical outcomes. It must be measured pre and post op fractured neck of femur to achieve best practice tariff as it is such a vital part of care. It’s probably as important as measuring blood pressure or oxygen saturations! The CQUIN is just good clinical practice and requires championing. The carers’ survey has the potential to change care and ideally should be imbedded into ward “dashboards”. How much Trusts value and use the information they receive from carers probably reflects their ambition to drive up standards of care.
The CQUIN can only be delivered by a campaign of hearts and minds backed up by support from a clear care pathway and system for embedding best practice. And above all by complete support from top down.
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Download: Chris Dyers Presentation6 October 2014