Dementia Strategy 2019-2022

­We have developed our strategy in consultation with our clinical divisions, hospital mental health services, commissioners including community services, local CCGs and local authorities, dementia patients and their carers feedback, local Dementia Organisations and research and development. We recognise that the views of our stakeholders are essential in ensuring we work together to deliver seamless services that improve the outcomes and experience for patients with dementia and their carers.

This strategy aims to respond to the national dementia strategy ‘Living Well with Dementia’ (2009) to:

  • Raise awareness and understanding
  • Early diagnosis and support
  • Living well with dementia

It describes the priorities for Nottingham University Hospitals NHS Trust for the next three years and will operate and adapt in the context of local and national initiatives. We will work with patients and their carers to deliver excellent care and outcomes. With our patients, local community and our staff we will review, develop and monitor our care in the following priority work streams:

  • Coming into hospital                      
  • Ongoing care in hospital                
  • Leaving hospital,
  • End of Life Care, 
  • People, Training and Culture. 

A Dementia Steering Group, chaired by the Trust’s lead for Dementia supported by five key work-streams, will provide assurance that clinical services and treatments provided by Nottingham University Hospitals NHS Trust meets best practice standards for patients with dementia and implement the national dementia strategy Living Well with Dementia (2009).

Coming into Hospital

Coming into Hospital

Coming into hospital can be a frightening and overwhelming experience for anyone but especially for a person with dementia.

We pledge to:

  • Screen all patients over 65 years on admission for underlying cognitive impairment, delirium and perform a standard memory assessment for those with known dementia,
  • Work with Rapid Response Liaison Psychiatry (RRLP) to ensure assessment and diagnosis,
  • Introduce routine use of 4AT as a screening tool for delirium,
  • Monitor development of new confusion using MEWS2 (April 2019),
  • Liaise with other known hospital departments as part of the patient’s care,
  • Ensure the completion of the About Me booklet for patients with dementia by the patient and their carers at the time of admission to ensure holistic care is delivered throughout the inpatient stay,
  • Ensure the pharmacy team prioritises seeing new admissions, aiming to ensure medicines reconciliation takes place within 24 hours of arrival at hospital,
  • Introduce dementia-friendly outpatient services,
  • Introduce dementia-friendly emergency department and acute admission units,
  • Identify those with a known dementia diagnosis at the time of admission through technological solutions.

Ongoing Care

Ongoing Care

Provision of high standard person-centred and compassionate care is what we expect for all. The hospital environment can be a distressing place for patients with dementia and their carers and minimising and alleviating distress is paramount. Hospital stays are recognised to be detrimental for patients with dementia as they are more likely to have longer lengths of stay and poorer outcomes. (Alzheimer’s Society 2016)

We pledge to:

  • Review and develop the whole hospital environment to ensure it is suitable for patients with dementia,
  • Minimise bed moves for non-clinical reasons during inpatient stays,
  • Minimise confusion and anxiety for patients and their carers when going to theatre,
  • Reduce incidence of delirium during hospital admission including High Dependency Unit or Intensive Therapy Unit stays,
  • Ensure patients are nursed out of bed when well enough and encouraged to remain mobile,
  • Reduce the number of falls sustained by inpatients with dementia and delirium,
  • Ensure patients are encouraged to dress in day clothes when well enough,
  • Develop dementia-friendly nutritional support and resources to meet the needs of individual patients,
  • Support dementia patients to take part in meaningful activities with trained support staff,
  • Support carers and staff in the management of behavioural and psychological symptoms of dementia (BPSD) and delirium,
  • Undertake a thorough drug review to ensure all medications are needed and appropriate,
  • Improve carer support and implement flexible visiting across the organisation,

 

Leaving Hospital

Leaving Hospital

Although the preference of patients with dementia may be to go home, the assessment by professionals within the multi-disciplinary team might show this to be too high-risk for some individuals. Decisions are usually made in the individual’s best interest with the involvement of the patient and their carers (Mental Capacity Act 2005).

We pledge to:

  • Ensure co-ordinated discharge planning,
  • Involve patients with dementia and their carers in decision making,
  • Promote a ‘home first’ approach where appropriate,
  • Establish strong working relationships and good communication with community teams,
  • Prioritise the transfer of patients with dementia to meet the needs of the patient and their carer,
  • Ensure information is shared with our community partners including pharmacy,
  • Ensure patients with dementia and their carers are given clear written information about their medicines, care arrangements and options for feedback.

End of Life Care

End of Life Care

Patients with dementia are often admitted to hospital in the last few days of life. Discussions on the admissions unit about options of treatments available and cardiopulmonary resuscitation can be distressing.

We pledge to:

  • Use the 5 priorities of Care from the Ambitions for Palliative and End of Life care national framework to identify and guide end of life care for patients with dementia and their carers,
  • Recognise and work with the hospital palliative care team around the SWAN model of care,
  • Aim to support the patient and carer with preferred place of death, 
  • Work with our community partners to optimise end of life provision for patients with dementia and their carers,
  • Enable smooth transition into the community by supplying any required anticipatory medicines and support.

People, Training and Culture

People, Training and Culture

Patients with dementia have complex needs exacerbated by unfamiliar faces and surroundings so having hospital staff trained in caring for patients with dementia is essential. We will equip staff with appropriate knowledge and skills to communicate effectively and become advocates for these patients.

We pledge to:

  • Establish new Dementia work-streams to achieve pledges in coming in to hospital, ongoing care, leaving hospital, end of life care and workforce training and culture,
  • Provide dementia focussed training aligned to guidelines by Health Education England Skills for Health, Skills for Care which will be mandatory for all clinical facing staff and volunteers,
  • Provide Dementia Friends training for all other staff,
  • Have active dementia champions in all Divisions and Corporate Directorates,
  • Increase dementia research and increase the numbers of patients with dementia and their carers participating in research,
  • Identify a dementia research and innovation lead and develop a research plan with the aim to be successful in securing NIHR infrastructure funding for dementia research in the 2021 NIHR competition for Biomedical Research centres and Facilities,
  • Improve partnership working with other Health, Social Care, Community and Voluntary organisations at local, regional and national level in order to meet the needs of those living with dementia and their carers,