AHPs join forces with other disciplines
They say if you have a good idea for a project, give it a memorable name. The IDEAS team in Dumfries and Galloway took this on board when they put in a successful bid for “Putting you First” money to launch a rolling programme delivering dementia training to care homes. The prize winning two year project finished in August 2014 with an array of great outcomes across the region’s care homes– a dramatic reduction in the use of anti-psychotic medication and benzodiazepines, much better staff morale with consequent lower rates of staff sickness, improvements in environmental design and in meaningful activity, with an impact on stress and distressed behaviour. A “train the trainers” component ensured homes could continue to deliver the modules to new staff after the end of the project.
The team is a multi-disciplinary task force co-ordinated by Lorraine Haining, Advanced Mental Health Nurse Practitioner, and overseen by Gladys Haining, (@gbhaining) Alzheimer Scotland Dementia Nurse Consultant (no relation!) For the Phase 1 two-year project, Lorraine was joined by a specialist from Psychology, and AHP input was provided by members of the Occupational Therapy Mental Health team.
Making a difference in acute sector
After this success in care homes, Lorraine was asked to provide a 6 month programme to deliver training in the acute sector. This is in line with the 10 Dementia Care Actions in Acute Hospitals from the National Dementia Strategy 2013 -16. A scoping exercise identified Capacity and Consent, and also Communication, as key issues, so for Phase 2 the two other members of the team were Frances Thielen, a Mental Health Officer from social work, and me, a Speech and Language Therapist. Both of us are Dementia Champions.
Foundation training is for any staff and covers common types of dementia and symptoms, and why ordinary everyday circumstances can cause alarm or confusion in a person with dementia. Practical exercises give participants the opportunity to experience some of the difficulties of living with dementia. We look at ways to offer effective person centred care to help reduce stress and distress.
Intermediate training is for clinical staff and has been delivered in three parts. The first focuses on delirium, as it is a medical emergency which often goes unrecognised. The team is recommending a new screening tool which facilitates identification of delirium and outlines a management plan.
Another vital part of intermediate training is the session on capacity and consent. It is against the law to make decisions on somebody else’s behalf unless legal authorisation is in place, and there are simple steps to take on the ward to ensure that a person’s rights are not being violated. The final element of training is on communication, and how important it is to adapt our interactions and the environment to compensate for the effects of dementia. This is difficult in a busy hospital and there are no fool proof answers, but we have some suggestions, and there are opportunities to talk through examples. We have also devised a component for dieticians, who have asked for training relevant to their role.
Well over 400 staff have been trained in total, though in some areas the limited availability of staff for training is an issue that has not been resolved. Questionnaires show attitudes and knowledge have improved and comments have been extremely positive. For the first time, domestic staff have attended clinical training, and they are keen to do more. They feel their improved understanding of dementia will help them enormously on the wards.
From the AHP point of view?
It has been great working in a wider multi-disciplinary environment and learning from different professions. We now have a much greater understanding of each other’s roles and where they differ, complement or overlap. This has potential to increase efficiency and effectiveness. For example, the dementia care mapping done by Lorraine ties in very closely with what I as a speech and language therapist do in analysing communication breakdown as a cause of distressed behaviour. I can contribute to strategies to compensate for communication difficulties, but can use her thorough observation rather than carry out another assessment. Similarly, Frances’ expertise in considering capacity issues dovetails well with speech and language therapy knowledge of communication techniques. She is suggesting that all mental health officers should have access to the communication training from the IDEAS programme, and I have taken back many of her useful documents to my team.
Together, we feel able to deliver a targeted training package which a range of staff can relate to. It is a model which fits well with the integration of health and social care, and allows different disciplines to share and build on each other’s knowledge. I’m only sad the project was so short! I can’t wait to see what the IDEAS team will do next.
What are your suggestions?
Rebecca Kellett, Speech and Language Therapist (SLT), Dumfries and Galloway Royal Infirmary until April 2015.
I work in the community with adults with acquired neurological problems, including dementia, and I’m a member of the Alzheimer Scotland AHP dementia expert group. I’m starting a new job with a specialist speech and language therapy team in Lothian working with people with dementia.