High Impact Change Area E: Improving the in-patient experience – case studies

The 16-bed Ruby Ward designed specifically for older patients is housed in a new stand-alone building, close to Maidstone Hospital. The facility will treat those with severe and complex mental health needs but many patients are also likely to be living with dementia. 

The investment was awarded to KMPT as part of a national drive to eradicate ‘dormitory’ style wards in inpatient mental health facilities, which no longer best serve patients’ care or safety needs.

Ruby ward, as it’s known, will serve residents across Kent and Medway and the new building increases capacity from 10 beds to 16 beds to meet inpatient needs for the county.

Features of the new inpatient unit include:

• 16 single ensuite rooms
• dementia friendly layout, environment and signage, in line with The King’s Fund guidance, including theming using colour and pictures, to enable patients to move freely and easily around the ward and through the corridors
• a dedicated space for providing a range of therapies – such as counselling, group therapy, creative activities – alongside facilities to help people relearn essential skills such as cooking and cleaning
• more space for patients and staff to receive and deliver care in
• more space for staff to change, shower and take breaks to support their wellbeing
• improved energy efficiency via use of solar power, under floor heating, thermally efficient fabrics and energy efficient LED lighting.
• four new gardens, which provide plenty of green spaces for patients and staff to enjoy.

Plan

The Dementia Meaningful Activities and Engagement Programme is focused on improving the experience of care for people with dementia admitted to hospital. The initiative has developed a range of support including dementia volunteer companions, a suite of person-centred meaningful activities and a programme of dementia learning for staff to improve their ability to manage dementia, supported by a network of dementia champions.

Implementation

A Patient Reported Experience Measures Survey (PREMS) concluded that patients in hospital cannot access meaningful activity or engagement and experience loneliness, boredom, fear and frustration. Subsequently, this impacts on patient wellbeing and leads to an escalation in challenging behaviours and the need for enhanced care.

Surveys conducted within the hospital also demonstrated negative feedback and experiences such as boredom and isolation, poor communication and general care including continence care/ oral care/ nutrition and hydration, multiple ward moves and a lack of recognition of needs.

The above led to an initiative that resulted in increased carer involvement in hospital by relaunching ‘Johns’ Campaign’ promoting proactive engagement with carers/ relatives and including more flexible visiting hours.

Bedside boards were implemented enabling families to record and capture patient needs and what matters to them. The boards are used to facilitate two-way communication with clinical teams. Additionally, the Dementia Daisy symbol was used at the patient’s bedside to help easier identification of a person with a diagnosis of dementia.

Dementia companions were trained to understand how to support those who may have behaviours that challenge and to spend meaningful time with patients, including supporting their ability to connect with families through FaceTime.

Outcomes

This initiative has resulted in a review of workforce models to consider the inclusion of additional roles that would have a positive impact i.e. an activities co-ordinator and wellbeing assistants. More training materials have been developed and induction programmes for newly appointed health care support workers have been implemented.

Furthermore, this initiative has been presented to the National Inpatient Dementia Network and National Patient Experience Group, ABUHB Hospital Dementia Steering Group, Quality and Outcomes Committee and Leadership groups.

Testimonials include:

I started chatting to the patient and we played ball. One of the questions was about his hobbies and interests. He told me he liked horse racing and had won on the horses - so I got the RITA out and we used the app on there to play horse racing and bet on the horses - we had great fun, and both really enjoyed it. When I was going, he asked me if I would come again”

Well, I’ve just come across a wonderful member of staff at NHH doing just this…. she has certainly put my mind at rest. His dementia has been taken into consideration prior to his treatment and the flexibility shown so far gives me more confidence. Thank you.”