Biggart Dementia Project Report 2009 / 2010
1.0 Situation 1.1 In NHS Ayrshire & Arran it has been identified that there is a need for improved education and training that supports staff in secondary care general hospital settings to meet the needs of patients with dementia when admitted to hospital and throughout their care journey. It is recognised that all hospital wards, clinical settings and other patients are affected by patients with dementia and the management of the specialist care needs of this patient group are, currently, not always being met. There is also a lack of information sharing between primary and secondary care when patients who have a diagnosis of dementia are admitted to hospital. 1.2 It has been recognised that improved sharing of relevant information between primary and secondary care, specifically when patients with a dementia diagnosis are admitted to hospital is important. 1.3 Within mental health services there is a wealth of specialist knowledge and skill in relation to dementia care which can be utilised to support the development of staff and enhance the care of patients across the organisation 1.4 The Dementia Training Group, established in 2009, brings together the expertise of practitioners from specialties across NHS Ayrshire and Arran and higher education with the purpose of achieving a co-ordinated approach to improving the knowledge, skills and confidence of staff when caring for patients with dementia. This will be achieved through establishing education and training resources tailored to meet the requirements of health board staff working in a variety of acute care settings and improving the information shared between primary and secondary care. 1.5 Within NHS Ayrshire and Arran the current population of people with a dementia diagnosis totals 5,496 Ayrshire Total Under 65 65+ Total 174 5,322 5,496 However projections over the next 20 years indicate this could increase by as much as 60% (Alzheimer Scotland 2010). 2.0 Background 2.1 Dementia will affect an increasing proportion of the Scottish population over time, both those with the illness and those who are there to give them care and support. The Scottish Government has identified dementia care as a priority in Scotland s National Dementia Strategy published on 1st June 2010. This strategy highlights the necessity for health boards to equip their staff in hospital settings to provide the improved care, treatment, experience and outcome of people with dementia admitted to general hospitals. The final report from work stream 3, Improving the general service response to dementia, outlines the following key area for improvement in relation to education and training: c. Improved knowledge and skills of all staff dealing with people with dementia. 2
2.2 The Dementia work stream of the Mental Health Collaborative responds directly to the current national HEAT Target for dementia which aims to increase the number of people with an early diagnosis and to support further improvements in their management and support. It identifies four key improvement objectives, one of which is: Improving public and staff awareness 2.3 The sub-group carried out a pre-dementia training survey to identify the current attitudes of all staff groups to dementia within the Biggart Hospital. A validated tool entitled Approaches to Dementia Questionnaire (ADQ) was circulated to all staff groups within the community hospital to establish a baseline to develop education and training on dementia, which resulted in the design of a tiered approach training programme. This nurse-led initiative delivered by the authors was implemented to improve approaches towards dementia within the Biggart Hospital and targeted all staff groups. 3.0 Assessment 3.1 As part of the Biggart Initiative work, a sub group of the Dementia Training Group has devised, piloted and delivered an approach to training all staff within the acute care setting. A number of approaches to training for staff has been delivered and tested including: Information sessions delivered by expert staff Tiered approach to training which meets the varying education needs of staff working at different levels and in different roles. Workbook approach to developing skills through self directed learning Mentorship and peer support from identified mental health colleagues Trained ward champions as drivers for development in clinical practice Information packs within clinical areas 3.2 Delivering good dementia care is a skilled task and staff need access to continuous development. It is not enough to tick a box regarding training when we are seeking to achieve cultural change in the workplace (Alzheimer Society 2010). This encapsulates the ethos of the sub-group in our aim to sustain dementia care skills and embed best practice in the clinical setting and beyond. Tiered Approach (Proposed) Tier 1: Clinical & Non-clinical staff Attend a 1 hour Awareness Session Tier 2: Dementia Champions Attend a structured 12 week programme utilising the University of Stirling Resource Pack and clinical placement within Mental Health Services Tier 3: All nursing staff supported by dementia champions Undertake Resource Pack or E-Learning Package Tier 4: Individual development ( further post registration studies / mental health issues Training 3.3 Tier 1: Awareness session In the Dementia Manifesto (Alzheimer Scotland, 2007) it is considered best practice for people with dementia, as with all older people, to be treated with dignity throughout their healthcare journey. To make this a reality in the clinical setting it is necessary to ensure all front-line staff, for example nursing, healthcare assistants, porters, housekeepers, administration staff should have some knowledge and understanding of dementia (The NHS Confederation 2010). 3
Therefore a nurse-led one hour awareness training session was developed and 18 sessions were delivered to a total of 112 staff between November 2009 & June 2010. On evaluation emerging themes were: the patient experience, how the person with dementia feels, approaches that could be taken back to the ward, and recognising people with dementia as individuals. 3.4 Post Dementia Awareness Evaluation Feedback To measure the impact of the Awareness Sessions a Post Dementia Awareness Questionnaire was designed and distributed to all participants. A large percentage commented that the session provided constructive interventions that they had been able to utilise, as well as valuing each others roles as well as recognising the care delivery from a patient perspective. 3.5 Initially the sub-group in partnership with University of the West of Scotland looked at several approaches to educate and train a selection of staff within the Biggart Hospital who could take forward best practice in dementia care, which hopefully would result in a more confident work force and improve the well being of the patients and carers. Unfortunately due to financial constraints the potential costs of working in partnership with the University was prohibitive. Therefore a programme was designed collaboratively between members of the sub-group (who included representatives from Mental Health and Acute Services) utilising Modules 1, 2 and 3b from the newly published Resource Pack entitled Caring for people with dementia in acute care settings by the Dementia Services Development Centre Stirling, of which 30 copies were obtained free of charge for the organisation. It was necessary to involve colleagues from elderly mental health services to ensure a robust programme that delivered on quality, transferability and values which focused on and delivered a person centred approach to dementia care. Therefore buddy wards and mentors from elderly mental health were identified before the commencement of the programme. This gave champions the opportunity to establish relationships with colleagues within mental health. Tier 2: Dementia Champions A Dementia Champion Programme was selected as the best model to promote hospital ownership of best practice in dementia care. The benefits of having a Dementia Champion are: To be a guide, supporter, mentor, and change agent To challenge bad practice in an appropriate manner To promote the well-being of people with dementia in the clinical setting To promote a person-centred approach and be a model for good practice To support relatives and carers thus enhancing their well-being and enabling them to continue in the their caring role To raise awareness, share information and knowledge To provide ongoing support in the workplace Consequently, enthusiastic and motivated individuals with a genuine interest in dementia care were identified by Ward Managers as Dementia Champions. A Staff Nurse and Healthcare assistant from 5 Wards within Biggart, and two Generic Workers from Kirklandside were involved in the 12 week programme. The champions completed three clinical placements to complement the modules in the 4
resource pack. In addition the modules were complemented by four supported sessions which allowed the champions to explore each other experiences, share new ideas for practice and problem solve. The sessions were also supplemented by carer narratives from a guest speaker and a representative from Alzheimer Scotland. 3.6 Dementia Champion Evaluation Feedback To ensure a robust evaluation the champions were provided a comprehensive questionnaire that examined their experience in relation to learning, implementing practice, practice placements, supported sessions and the resource pack. They concluded that the Dementia Champion programme was extremely beneficial in providing them with an opportunity to network with mental health colleagues, who they now see as a resource that can be utilised in the future. Through sharing case studies and practice experiences with other champions and mentors a wealth of ideas were identified to take forward within the general hospital setting. 3.7 Dementia Mentor Evaluation Feedback The Mentors were asked to evaluate the resource pack, value of placements and the supported sessions. Overall they acknowledged that the programme provided opportunities to share practice and for networking, as well as enhancing collaborative working in utilising and implementing the resources identified during the programme. 3.8 Charge Nurse Evaluation Feedback The Charge Nurses were asked to provide in their opinion the level of impact that the Dementia Champions have made during the programme Overall the Charge Nurses perceived that since undertaken the programme the Dementia Champions have made a positive impact in their own clinical setting. For example, influencing other colleagues to implement best practice in dementia care. 4.0 Conclusion The sub group acknowledges the difficulties in releasing staff to attend specific training sessions and agrees that adoption of an integrated approach to delivering awareness and training to staff while working in clinical practice will improve and enhance the knowledge and skills of staff caring for patients with dementia. The group has achieved its objective to devise, pilot, deliver and evaluate an approach to training all staff within the acute care setting. Although it is worth noting that during this period of time the authors were involved in several other projects as a direct result of initiating this training. 5.0 Recommendations With this in mind the Group wishes to progress the development of a training package based on the work at Biggart Hospital which includes resources identified within this paper. Due to political agenda and financial constraints a variety of methods in ensuring that all staff are exposed to education and training is required. However, it is vitally important to maintain a sense of reality and empathy part of this training must be face to face to ensure robust interaction and discussion on the impact of current practice. The sub group therefore recommend that all staff are exposed to a 1hour 5
fundamental dementia awareness session with facilitation. Training is rolled out to all Older People Services sites in the first instance. Training could then be targeted at specific areas within Ayr and Crosshouse Hospital to maximise impact. All nursing staff should then adhere to a tiered approach to continuous development and service improvement by undertaken either the University of Stirling Resource or a Learn Pro web-based development package. To enhance the role of the dementia champion similarly minded individuals need to be identified and undertake a similar programme. Existing champions should be utilised by the organisation through continuous development and participation in a variety of dementia services e.g. involvement with carer events, audits To ensure service improvement the champions should meet bi-monthly with a structured programme with the dementia liaison nurse Jim Mack, Biggart Initiative Facilitator Julie Crabtree, Dementia Liaison Nurse July 2010 6