We are proud to care. UH Bristol film that shows the Trust over a 24hour period

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1 We are proud to care UH Bristol film that shows the Trust over a 24hour period

2 UH Bristol Update Rachel Price Lead Dementia Practitioner

3 The Trust UH Bristol has over 8000 staff, delivering over 100 different clinical services. There are eight hospitals within the centre and south of the city. The Trust has invested over 150million in modernising our buildings. This has included development of three sites BHOC, BRHC and the BRI. Dementia we have seen an increase in numbers, which reflects the national data approx 170 patients admitted each month.

4 UH Bristol Data Numbers of patients admitted approx 2000 in 2015/16

5 What is Dementia? Dementia is an umbrella term use to describe a set of symptoms Memory loss Difficulty working new things out Disorientation Changes in language skills Mood changes Impaired concentration Difficulty in learning something new Changes in judgement Inability to manage everyday activities

6 Types of Dementia There are many different diseases that cause the symptoms: Alzheimer s Disease is the most common cause, affecting about half a million people. Abnormal plaques and tangled fibres can be seen, with a loss of connection between brain cells. The cause is yet to be identified. It s a gradual process. Specific medications can be prescribed to potentially the process of decline.

7 Types Vascular Dementia Second most common cause. Caused by problems with the blood supply to the brain. The symptoms generally come on more suddenly than Alzheimer's. There can be a distinct moment when the blood vessel gets blocked, causing a sudden deterioration. Some people have a Mixed Dementia vascular & Alzheimer's.

8 Risk Factors Ageing! Chance of developing Dementia increases with age, particularly over 65yo. Likely due to factors associated with the ageing process. Gender Women are more likely to develop Alzheimer s Disease than men, though the reason why is not known. For Vascular Dementia, men have a slightly higher risk. Other types it s about the same for both genders Ethnicity South Asian, Afro-Caribbean and African ethnic groups have a higher risk. Genetics Certain genes can increase your risk.

9 Manageable risks What is good for the heart, is good for the brain! Regular physical exercise - 5x weekly of 30mins. Not smoking - whenever you stop, it will benefit your health Drinking alcohol in moderation - max 14 units in a week, over three or more days. Maintaining a healthy diet a healthy balanced diet Keep mentally active doing something enjoyable that stimulates the mind, e.g. learning a new language. Be sociable keeping socially engaged with a strong network around you

10 Research Research is currently looking into the cause, cure, care and prevention of Dementia. Join Dementia Research is service which allows people to register their interest in participating in dementia research and be matched to suitable studies. The Alzheimer s Society is currently the only charity funding Dementia research.

11 What is UH Bristol doing to support our patients who have a Dementia and their carers?

12 National Drivers In 2012, David Cameron set the first Prime Minister s Challenge for Dementia. The Challenge on Dementia 2020 was launched in This builds on the first challenge. Key points for UH Bristol: Increasing public awareness of the factors which increase risk of developing Dementia To provide meaningful care post diagnosis for them and those around them in accordance with national guidelines. (NICE) All NHS staff to have training appropriate to role All hospitals to meet agreed criteria to becoming Dementia friendly

13 The CQUIN For the past 3 years, we have been working towards the National Dementia CQUIN an initiative set by the DoH to improve patient care in some way, with a financial reward on achievement. The Dementia CQUIN was composed of: Find, Assess, Investigate and Refer patients who may have a Dementia, admitted as an emergency and over 75yo To ensure an appropriate training programme is in place To ensure carers of those with a Dementia or Delirium are adequately supported. (Commissioning for Quality and Innovation Guidance 2015/16)

14 Dementia CQUIN After 3x years we have achieved the CQUIN!! We have successfully created a sustainable method of recording the FAIR elements, through the e-handover system and e-discharge. The carers survey is progressing, with the aim being that the wards take over this survey to ensure it continues. Education and training all staff have awareness training at induction. E-learning and the workbook continue to be available for staff.

15 Training of staff All staff have Dementia awareness as part of the Trust induction clinical, Doctors, non-clinical and volunteers. We use Barbara s story film to demonstrate how Dementia impacts on the individual. There will be e-learning available in the autumn, that is linked to our learning portal. We have a workbook and there is bespoke training for individual teams and areas. We are looking at different ways to train our staff taking a more practical approach to help staff put themselves in the patient s shoes

16 GERT The GERT age simulation suit has been a useful tool in staff training. Helps staff experience the challenges of being older, with restricted joints, movements, vision and hearing.

17 The Environment The investments in the new ward blocks and the refurbishment of existing areas has improved the environment for our patients with Dementia. The next phase out-patients are also ensuring that the environment in the clinics are Dementia friendly. We had a successful PLACE inspection last year, with an average of 90% in all areas.

18 Patient Engagement Activity boxes and enhanced supervision Boxes are being provided to all the wards within the Medicine division. They contain puzzles, games, paints, twiddles etc

19 Patient Engagement Bright Ideas this is looking at activity boxes and training for NAs to provide an improved patient experience on A602. Staff surveys were completed to establish learning needs. Training was completed for all NAs between January April. The box was launched in April, with staff stepping up to the change in practice. C808 also have developed an activity box to use with their patients. They are piloting an IPad to use for reminiscence, apps for games, YouTube for film and music clips. Both projects are evaluating the boxes, with the aim to roll out across the organisation.

20 Activities in action

21 ipads

22 Twiddles Twiddles are knitted / crocheted muffs or blankets, with items attached. They provide a source of, visual, tactile and sensory stimulation, whilst keeping you warm. Since May we have lucky to have regular contributors to the Twiddle cause! Feedback from carers / staff is very positive. The call has gone out for the closet knitters within the Trust!

23 Twiddles

24 Visual identification We use the forget me not symbol to help staff identify when a patient has a cognitive impairment which could be a Dementia, Delirium or confusion caused by some other cause. The flower symbol is on the main patient board, above the bed, clipped to notes if going to another department.

25 Champions Champions are staff, of any grade or profession, who want to improve the experience, care, treatment and outcomes for people with Dementia, families and carers whilst in UH Bristol. We have an ever growing list of Champions about 130 on the database at present. We hold 2x Champions conferences a year, a UH Bristol specific one and a joint one with NBT. The joint conference has now been opened up to include colleagues from NBT, St Monica Trust and Bristol Community Health.

26 Carers We know carers provide a vital role at all times including when the person is in hospital. We share a joint Carers Charter with North Bristol Trust. UH Bristol was one of the first organisations to embrace John s campaign. The campaign is publicised at any opportunity, to remind staff of the need to support carers during the stresses of a hospital admission.

27 Carer s Support The opening of the Dementia Support café has been a highlight of the year. A grant from Above & Beyond enabled this to happen. The Trust team are supported by Jamie (Carer s Liaison Worker) and Hazel (Dementia Navigator Bristol Dementia Well Being Service). The Trust volunteers support as able, plus the Later Life Mental Health team. We have had a wide range of people attend staff with patients, carers, students The feedback has been very positive to date

28 Carer Liaison Service Who is a carer? A carer is someone who provides unpaid support to family or friends who could not manage without this help. They could be caring for a relative, partner or friend who is ill, frail, disabled or affected by mental ill-health or substance misuse. A carer can be a young person under 18 who may be caring at home. The Hospital Carer Liaison Worker is based in the hospital can: Provide help, support and advice to carers while the person they care for is in hospital Liaise between hospital staff and a carer and their family Give training to staff on carers issues Support staff with their work with carers

29 All About Me This will replace the This is Me. It contains the same information but in a different format, following feedback from carers. It asks details about the person, e.g. likes, dislikes, interests, family details, daily routines.

30 Expectations This sets out the practices that patients and carers should see within our organisation. It covers a wide range of areas including: Carers Eating & drinking Medication Personal care Pain management Responding to behaviours

31 The Team Helen Morgan Deputy Chief Nurse is our organisational lead. Dr Meera Sritharan Consultant is our clinical lead The Trust has invested in the team this year. We are now 3.0 wte staff Lead Practitioner, Nurse Practitioner and a Support Worker. The roles all encompass Dementia and Falls, as the two are strongly linked.

32 The Future Develop further our networks & joint working with our colleagues in external agencies. To support the wards in their creativity to actively engage with patients and carers, e.g. embedding the activity boxes, twiddles and the ipads. Review the Dementia training that is offered to staff, developing new ideas to deliver training. To work alongside the Divisions as the Enhanced Supervision projects evolve support with training of staff, joint working. Work with Above & Beyond And so on

33 Thank you

34 Group work We now have time for you to discuss and hopefully come up with some ideas to answer the following: How can we further improve our care of those with a Dementia in our hospitals? How can we support carers of someone with a Dementia? Have you any ideas / comments generally? We will share some of the ideas as a large group. Ideas and comments will be shared with the Dementia Strategy Implementation group

35 Question and Answer session

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