As part of our Dementia Friendly Hospitals Charter relaunch we’ve been speaking to senior dementia specialists from hospitals that are signed up to the charter. Caroline Ashton-Gough is Dementia Clinical Nurse Specialist at Princess Alexandra Hospital and provides an update on the progress made within the hospital and how that relates to the charter.
1. Which hospital do you work in? Could you tell us a bit about it?
I work at The Princess Alexandra Hospital in Harlow as a Dementia Clinical Nurse Specialist in the Dementia Support Team. The Dementia Support Team is supported by a Dementia Support Practitioner and a Quality Improvement Matron. We are a District General Hospital with 379 beds. We have one of the busiest Emergency departments in the country. The Trust employs more than 3,000 staff. Our innovative dementia services have been developed and embedded over the past decade and include our recently opened 27 bedded specialist Dementia /End of Life ward providing care for patients with a diagnosis of dementia in an appropriate/calm environment with skilled staff who are supported by the Dementia support Team and the Specialist Palliative care team. We provide help and support to patients with an existing or suspected dementia diagnosis and their family and carers in all areas across the Trust. We have developed a bespoke staff training and education programme, which employs a tiered approach to staff competency informed by nationally recognised frameworks. We have supported other staff groups such as security staff in a specific training programme which included the VDT (Virtual Dementia Tour). We recognised that this staff group supports the ward staff with patients and that they had not received any training. All the security team are now trained in dementia care and have commented on the positive impact this has had on their approach to patients. In response to the results of the National Audit of Dementia 2017 we have developed a Quality Improvement Project focusing in on delirium to raise awareness and improve the care patients receive. While we recognise that anyone can get delirium, it is not just secondary to a diagnosis of dementia, we recognise that it has a significant impact on people living with dementia including, increased length of stay, deconditioning, risk of institutionalisation and mortality. Specialist staff lead by example and equip the workforce with the confidence to challenge dementia related stigma, myths and poor practice. Building on our innovative services, we are currently working through our 5 year Dementia Strategy 2015-2020, which outlines our ambitions and commitment to become a truly dementia friendly community that strives to consistently deliver high quality person-centred care that meets the needs and expectations of our patients and their family and carers.
2. What does your role involve?
As Dementia Clinical Nurse Specialist, I support/lead on the implementation, evaluation and review of our Dementia Strategy. I lead on the Quality Improvement project for delirium; this has involved organising a Delirium awareness week, developing staff information leaflets, resource folders, carer’s information leaflets and a planned conference on the 5th November. I am leading on the review of the Dementia and the Delirium pathway. I have implemented/developed a carers group for carers in the trust who are supporting people living with dementia and I am supported by the dementia support practitioner. I assess and support patients in inpatient ward areas, attend case conferences and support other professionals with advice. I work clinical shifts alongside ward staff in our complex care ward areas to role model and identify patients/carers who may be in need of additional support. I have reviewed our staff training and developed bespoke training for our security staff. I am currently in my second year of a Doctorate in Health Research looking at the nursing relationship in supporting carers of patients with delirium superimposed on dementia. I am an active participant in clinical audit. I am a member of the Trust End of Life Steering Group and work alongside the palliative care team in supporting patients with dementia who may be nearing end of life. I have an MSc in Advanced nursing practice, MSc in Advanced care in Dementia and a BSc in specialist palliative care and work shifts in the Specialist palliative care team. I run some simulation/scenario based training for patients with dementia at end of life. I am a trained facilitator for the Virtual Dementia Tour. I have recently attended the Sue Ryder training programme in Human Rights at end of life and alongside another colleague I will be leading on the implementation of Human Rights Training in our Trust. I am a member of the British Geriatric Society. I lead on local and national audits including the National Audit of Dementia. I ensure that we engage with the local community by reaching out for every opportunity to work more closely with our community colleagues and have attended Harlow Rainbow Services events and delivered training and presentations in Dementia Care. My role has included supporting many improvement projects and fundraising, most recently our Dementia Garden, supported by dementia volunteers who support people living with dementia working in the garden.
3. Has the dementia friendly hospital charter helped you and your staff when providing care to people living with dementia?
Our Dementia Services have developed since the introduction of mandatory training in dementia care pre-dating the DAA’s original ‘Call to Action’ for the improvement of care for people with dementia in acute hospitals. The Dementia Friendly Hospital Charter has helped us to reaffirm our approach, stay focused and avoid complacency. It provides clear standards and expectations that our patients and their family and carers can expect and has helped to inform our ongoing strategic review. We have also been able to network and benchmark with other organisations, by visiting their organisations, attending study events and conferences, to help further improve standards.
4. Are there any particular elements of the charter that have been important in your hospital?
All parts of the charter are as important to us as they are to those living with dementia and their family and carers. A small example of our more notable developments that mirror expectations of the charter include:
- Staffing – In addition to our formal training and education programme, we have also recruited and trained 47 ‘Dementia Champions’ and our new role of dementia volunteers. We currently have 3 volunteers, supporting our dementia garden project and the pursuit of raised dementia awareness and supporting patients during their hospital stay. The role of Delirium champions will be launched by the RCN (Royal College of Nursing) at our delirium conference.
- Partnership – We have developed a Carers Card and Carers Policy, which includes flexible visiting. We are strong advocates of John’s Campaign to enable carers to visit and assist as necessary at any time of day or night, including mealtimes. The trust provides meals for relatives and reduced rates of parking.
- Assessment – The pre assessment clinic will advise us of any patients coming in for planned surgery that have dementia that may need additional support. One of our colleagues who is an assistant theatre practitioner (who also has a husband who is living with dementia) has developed a video explaining the pathway for patients living with dementia coming in for planned surgery until discharge. She has recently won an award for this with our Quality improvement Projects.
- Care – We have designed, supported and developed and opened a reminiscence room within one of the ward areas and we are working towards developing bespoke areas in other departments. In addition to the bespoke environment on our specialist ward. We are working towards a programme of therapeutic activities, including digital reminiscence (fund raising is in progress), pet therapy and multi-faith chaplaincy. Our Delirium project aims to improve recognition, assessment and treatment of delirium in dementia. Our work in supporting carers is growing, most recently facilitating a Dementia Seminar Training session supported by Dementia Adventure.
- Environment – We have been involved in the redesign of ward areas when being refurbished. In preparation for our new hospital planned for 5-10 years’ time we have been invited to give our opinion and advice in ensuring the environment will be suitable for people living with dementia, ensuring a standardised approach to dementia friendly design.
- Governance – We are fortunate to have support from the highest level of the organisation and a highly skilled and passionate team. We are active members of our local DAA and are currently working towards developing Harlow as a designated ‘Dementia Friendly’ Community.
5. Why do you think other hospitals would benefit from signing up to the charter?
Every person living with dementia and their family and carers deserve the very best of care when encountering a hospital visit or stay no matter where they live in the UK. All hospitals should sign up to the charter in order to provide national consistency of standards and assurance to patients and their family and carers. The Dementia Friendly Hospital Charter provides a very clear set of minimum standards with notes for self-assessment, which helps with the development and update of action plans and strategies. Being a member of the Dementia Action Alliance and signed up to the Dementia Friendly Hospital Charter provides networking opportunities, enables benchmarking with other organisations, and highlights good practice examples and learning opportunities.
6. What is your favourite thing about working in your hospital?
After nursing older people with dementia for over 31 years, becoming part of the team that continues to work hard to develop dementia services within the Trust and sharing the successful model with other organisations across the UK has been particularly satisfying. I feel privileged to work with staff at all levels within the organisation who demonstrate such passion, enthusiasm and commitment to providing excellence in dementia care. I also enjoy representing the Trust as a member of the local Essex DAA in the pursuit of maintaining excellence in Dementia Care. Undoubtedly, the best thing about my role is making a positive difference to the care experience of patients with dementia and their family and carers both directly and indirectly. Additionally supporting staff that may have relatives/friends who are living with dementia and being proud to be a nurse.