By Grace Hampson,
New Cross Hospital Dementia Project.
New ways of treating people who happen to have dementia (as well as other health issues) are being developed at New Cross Hospital. The New Cross Hospital Dementia Project entails ground-breaking work to support people who come into hospital for physical reasons and who also have dementia.
The West Midlands Strategic Health Authority commissioned this two-year project, at a cost of £480,000, with New Cross Hospital as a test site. The project involves the collaboration of multiple organisations including Wolverhampton PCT, Wolverhampton City Council and Social Services. It involves a comprehensive and radical approach, working on a whole system basis.
Dementia Care Bundle
A “dementia care bundle” has been designed to improve clinical outcomes within an acute hospital setting and provide more cost-effective care for people with dementia. This bundle comprises the following elements:
- Hydration and Nutrition
A 20 bed Physical Illness and Dementia Ward at New Cross Hospital has been opened for people who have dementia as well as the health condition for which they are being treated. This ward has been designed to help engage patients with activities and things of interest to them. Specific measures to make the ward dementia friendly include:
- A toilet door that can be seen from everywhere on the ward, with a sign that is bright and easily visible.
- Other doors which patients do not need, such as those to cleaning cupboards, blend in with the walls.
- Everything around each bed is within easy reach.
- The bell can be seen easily.
- A table, which permits patients who are well enough to sit with others to eat.
- A garden, and a reminiscence area, to encourage patients to engage.
- Space for relatives to stay should they wish.
Hydration and Nutrition
Special attention is given to ensuring patients eat and drink enough. This involves checking that people get the drinks they actually like, and giving help with drinking if required.
All staff, from porters to nurses and doctors, receive training in communication with people with dementia. This involves reading body language, making eye contact, and knowing how to understand what may be happening when a person is not responding verbally.
When patients are admitted to the ward, they are allocated a carer. The carer engages with the patient and family members, learning in detail about the things that matter to the patient. This communication covers a whole spectrum of interests ranging from important details, such as who else is in their family, all the way down to little considerations such as whether they take sugar in their tea. This enables the carer, and the wider team, to give individualised person-centred care.
Patients are checked at regular intervals, around once an hour, to see if they are happy or if they need anything.
Outreach and Training
Not all patients with dementia can be located on the dedicated dementia ward. Patients who have had a stroke, for example, need to be on a ward dedicated to caring for people with this condition.
The New Cross Hospital Dementia Project has an outreach team, going out to wards throughout the hospital to visit patients and staff, thereby enabling them to put improved dementia care into practice.
The intended outcomes of the New Cross Hospital Dementia Project are:
- A reduction in falls, infections and pressure ulcers.
- A reduced length of stay and fewer discharges to institutional care.
- Improvements to staff training.
- Provision of person-centred care to patients with dementia.
- Improved patient and family satisfaction, resulting in fewer complaints.
- Reduction in the cost of care, both for the hospital and for the whole care system within Wolverhampton.
- Development of an evidence-based care bundle, which will be shared in the West Midlands, nationally and possibly internationally.
Components of the Project
The New Cross Hospital Dementia Project entails six active work threads:
- Person Centred Care: responsible for development of the care bundle and associated care processes.
- Medical / Therapeutic: developing the clinical model of care, admission criteria, clinical protocols, pharmacology and audit.
- Training and Development: ensuring all staff across the Trust have, at the minimum, some knowledge and understanding of dementia.
- Built Environment: adapting the dedicated ward to meet the needs of people with dementia in an acute care setting.
- Metrics / Outcomes: developing a set of measurable outcomes, compatible with Commissioning for Quality and Innovation (CQUIN) indicators.
- Evaluation: setting baseline measures and testing the overall effectiveness of the care bundle and the whole programme. This will be validated externally and is chaired by Professor Dominic Upton at the University of Worcester.
The project began in July 2009 and will be evaluated robustly by independent specialists in July 2011. It is hoped that the findings will be shared throughout the West Midlands, nationally and perhaps internationally.
Hampson, Grace. (2011). New Cross Hospital pioneers new model of dementia care. NHS Local, January 17th 2011.
Hampson, Grace. (2011). How New Cross Hospital is improving care for people with dementia. NHS Local, January 17th 2011.
Hampson, Grace (2010). Delivering excellence in dementia care in acute hospitals: proposal for the New Cross Hospital Dementia Project. Wolverhampton: The Royal Wolverhampton Hospitals NHS Trust, May 10th 2010.