Focus on Dementia in partnership with colleagues in Aberdeen Royal Infirmary have produced a publication which explores the critical success factors which lead to improved outcomes for people with dementia, their carer’s and staff in acute care, which we would like to share with you. Focus on Dementia is a national improvement portfolio based within the ihub of Healthcare Improvement Scotland. We work in partnership with national organisations, health and social care practitioners, people with dementia and carers to reduce variation and improve quality of care.
We know that people living with dementia are more likely to be admitted to hospital than people without dementia, and are estimated to occupy 25% of acute inpatient beds. This means that approximately 6% people living with dementia are inpatients at any one time.
When admitted to acute care they tend to have a longer length of stay, have more adverse outcomes such as falls, pressure ulcers and infections, and are more likely to be discharged to a care home.
Scotland first developed a national dementia strategy in 2010, with commitments around improving the outcomes and experience of people with dementia and their carer’s. Commitment 10 of Scotland’s second national dementia strategy focused on improving acute care for people with dementia. To support this commitment, 10 Dementia Care Actions were agreed.
As part of this work Focus on Dementia aimed to identify the critical success factors associated with positive outcomes for people with dementia, their carers and staff in acute care by exploring the success factors in a department which had demonstrated good practice in relation to the 10 Dementia Care Actions, the Department of Medicine for the Elderly, Aberdeen Royal Infirmary.
We used an appreciative inquiry approach to capture information on the success factors within this department from a range of sources, including a multidisciplinary workshop, conversations with staff, stakeholder questionnaires, data collection and thematic analysis using the 10 Dementia Care Actions as a framework.
The project identified 15 different critical success factors under the 10 Dementia Care Actions. The main themes we found were:
Quality improvement is every day and everyone’s business
The whole multidisciplinary team were involved in agreeing and working on improvement priorities using improvement methodology. This was supported by the local leadership within NHS Grampian. They meet every week as part of their “QI Fridays”.
Focus on dementia-specific knowledge and skills/leadership
The department make a real effort to ensure the staff had the appropriate level of dementia specific knowledge and skills. They also utilise the support from the local subject matter experts such as the local Alzheimer Nurse Consultant and the Older Adult Mental Health Liaison Team.
Focus on delivering good person-centred care
The department use person-centred approaches such as “Getting to Know Me” and “What Matters to Me” and shared documentation to really get to know their patients and their needs and to inform care planning.
Focus on making best use of the care environment
The department improved the physical environment using audit and dementia-friendly design including improved lighting, reducing noise levels, improved décor in dayrooms, murals to add interest and signage to support way finding. Therapeutic activities are recognised as an essential part of day to day life and not an add on.
You can find our much about this work including; what the critical success factors identified were, why they are critical and how the department achieved them in a publication we produced to capture the learning. This will inform improvement work in acute care supported by Focus on Dementia and the wider acute care programmes in Healthcare Improvement Scotland. We feel the learning from this work will be of interest to other inpatient sites across Scotland, and staff will be able to use the learning to identify opportunities to improve the care and experience for people and people with dementia their own areas. The link for the publication can be found here.
Lynn is a HCPC registered Allied Health Professional (Physiotherapist) working as an Improvement Advisor as part of the Focus on Dementia Team in the iHub of Healthcare Improvement Scotland
Twitter: @ihubscot @FocusOnDementia
Alzheimer Scotland Dementia Nurse Consultant