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

1. A View from the Bedside. Getting it Right for Vulnerable Patients Ms E Childs Director of Nursing and Governance Executive Lead for Safeguarding Adults Dr G. Kendall Consultant Care of the Elderly Clinical Lead for Dementia

2. 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

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

4. Dementia - Improving Care at the Bedside Who:- 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 Nursing member of Torbay Learning Disability Partnership Board Medical Champion: Consultant Physician Care of the Elderly Clinical Nurse Specialist Dementia Care Supported by increasing ‘dementia champions’ Mental Capacity Act/ Safeguarding Adults post

5. 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’

6. Dementia - Improving Care at the Bedside • Observations of care – replacing ‘real time’ patient feedback questionnaires • Weekly process • 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 • What do I see? • What do I hear? • What do I smell? • What do I feel?

7. 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

8. Dementia – Improving Care at the Bedside

9. Dementia – Improving Care at the Bedside The Board Round – Benefits:- • 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

10. Dementia – Improving Care at the Bedside

11. Dementia – Improving Care at the Bedside The Board Round – Pros and Cons

12. Motto – “if we get it right for patients with Dementia – we get it right for everyone!” Thank you!