University Hospitals of Leicester NHS Trust Dementia Implementation Plan Work-stream 1: Ensure Governance Arrangements

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1 Work-stream 1: Ensure Governance Arrangements 1. Involvement of the Executive Board with Senior Clinical Lead identified with support roles Trust Board will review quarterly; Information on number of readmission rates, delayed discharges, falls and outliers of people with dementia Will review patient and carer experience feedback 2. Public and Patient Involvement (PPI) patient and carer feedback In partnership with Alzheimer s Society and Age UK, hold a patient and public engagement event Ensure there is Patient and Public Involvement representative on UHL Dementia Steering groups 3. Dementia Champions on wards Dementia Champion training workshops are accessible to all staff groups on wards and departments Ensure we have dementia champions on all wards 4. Nutrition ensure protected mealtimes are supported on wards Protected mealtimes are established and monitored in all areas that admit adults with know or suspected dementia 5. Improve hospital coding for dementia to enable us to collect and act on data Patients with known dementia are coded as part of the admission process Page 1 of 10

2 Work-stream 2: Comprehensive Assessments 1. Implementation and evaluation of the Dementia Care Pathway (DCP) Implement and evaluate the Dementia Care Pathway which people with dementia follow when admitted to hospital Provide DCP training to all current and future medical staff to ensure the pathway is followed 2. Dementia screening and standardised mental health questions Assessment of a persons mental state is carried out on all patients >65 years when they are admitted to hospital to detect any early signs of dementia Monitor data of people screened with dementia in hospital 3. Assessment for Delirium Guidelines will be implemented and monitored to ensure patients with dementia are assessed by a trained workforce for the presence of delirium 4. Assessing Pain People with dementia will receive a pain assessment, suitable to the individuals mental functioning and ability to respond to questions Implement a training roll out plan to introduce a pain assessment tool to wards who admit people with dementia 5. Nursing documentation Nursing documentation will be regularly audited to ensure it reflects patients needs in relation to a persons mobility, nutrition, pressure ulcer and continence needs To pilot a nursing care plan to help in caring for someone who is admitted with confusion Page 2 of 10

3 Work-stream 3: Interventions for Behavioural and Psychological Symptoms of Dementia including Prescription of AntiPsychotic Medication 1. Practice and protocols are in place to review antipsychotic medication on admission and discharge Patients with dementia will have a review of antipsychotic medication on admission and discharge (or transfer) Routine audits of in-hospital prescription of antipsychotic medication is carried out on inpatient wards 2. Behavioural and Psychological Symptoms including de-escalation and management of challenging behaviour 3. Meaningful Activity Facilities and Forget me Not Volunteers Clear guidance will be in place, governing the use of interventions for patients displaying violent or challenging behaviour, aggression and extreme agitation, including patients at risk of wandering Staff will have access to de-escalation training and have a point of contact for further support Staff will appropriately monitor effects of any antipsychotic medication given Meaningful Activity Facilitators will act as a resource and support for patients and ward teams (where based) providing activities in conjunction with the Patient Profile and Carer involvement Forget me Not volunteers will be trained to provide additional support to patients with dementia where requested 4. Environmental factors Environmental factors such as noise, lack of activity and disorientation will be reviewed when a patient displays Page 3 of 10

4 Page 4 of 10 violent or challenging behaviour, aggression and extreme agitation Future ward environments will reflect the needs of people with dementia

5 Work-stream 4: Liaison Psychiatry Services 1. Access to a liaison psychiatry service 24 hour 7 days a week Provision of adequate numbers of psychiatry staff with appropriate experience to support 24/7 service 2. Referrals to the psychiatry service Audit of access and response times to assess service viability Ensure that referral criteria and mechanisms are cascaded to all appropriate staff Page 5 of 10

6 Work-stream 5: Hospital Discharge and Transfer 1. Involvement of patients and carers and provision of adequate information on dementia In partnership with patients and carers, discharges and transfers are actively planned from admission onwards A Carers assessment of current needs has taken place prior to discharge 2. Patients with dementia should only be moved if it is deemed necessary for their specific care 3. Patient with dementia should be transferred or discharged in the day time Patient movement events will be monitored for standard compliance Patient and carer feedback will be monitored Discharge protocols will reflect the risks of moving people with dementia out of hours ie late evening Audit patient movement and events to monitor compliance with standard protocols Page 6 of 10

7 Work-stream 6: Information and Communication 1. Patients with dementia will have a Patient Profile to support their care delivery and when communicating with people with dementia All patients with dementia admitted to hospital will have a Patient Profile completed by a carer/relative as soon as possible from admission Audit compliance in the use of the patient profile and 2. Patients and their carers should be offered information on dementia. Carers will be involved in patients care planning and treatment 3. Staff will be able to easily identify people with dementia on the ward or when transferred to different departments educate relevant staff in its use Monitor and act on patient and carer feedback regarding communication and information giving in hospital Carers will be offered to attend a bespoke information programme led by Alzheimer s Society (CrISP) A Communication assistance sign (Forget me not symbol) should be introduced across the trust for people with dementia Investigate the use of an alerting mechanism within IT systems to identify patient with dementia 5. End of life care for patients with dementia The views of patients and carers and any advanced decision are incorporated in end of life care planning End of life pathways and protocols reflect the needs of people with dementia Page 7 of 10

8 Work-stream 7: Staff Training 1. A Dementia training framework will identify necessary skill development of staff in working and caring for people with dementia (Dementia category A, B, C) Staff groups identified, will receive Dementia training relevant to their role There will be an assessment of staff knowledge and understanding of dementia care in practice 2. Delirium Develop a delirium assessment tool, providing appropriate training in the care management of a patient with delirium 3. Dementia Champion training Ensure all wards and departments have access to dementia champion training To develop a structure on Dementia Champion Leads Page 8 of 10

9 Work-stream 8: Improving the Experience of People with Dementia and their Carers /Dementia Friendly Hospitals 1. Dementia Friendly Environments Principles of Kings Fund in conjunction with recommendations from the Quality Mark Scheme will be adopted to promote dementia friendly environments Patients and carers will be part of future service redevelopment meetings 2. Dementia Action Alliance UHL will support National agendas linking to local Dementia Action Alliance working groups and sharing best practice with other hospitals 3. Support local Alzheimer s Society initiatives to improve patient and carer outcomes Support a pilot Hospital Liaison Service to enhance the experience people with dementia and their carers 4. Patient and Carer feedback Gain feedback from the perspective of people with known and suspected dementia and their carers through public and care engagement ie, by attending dementia cafes Page 9 of 10

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