Leading change

A Senior Healthcare Assistant (HCA) and Dementia Champion within the Royal Preston Hospital Emergency Department developed an adapted patient identification wristband that supported staff to recognise that a patient may have additional needs related to their diagnosis of dementia. The innovation has been well received by patients, their families and carers and staff working at the Royal Preston Hospital.

Where to look

The Senior HCA identified that although dementia care in the Emergency Department was of a high standard there were ways to enhance dementia care, particularly for patients in the later stage of the condition. The improvements include using a discreet adaptation to existing wrist bands. These would notify any member of staff that the patient has dementia and that they needed to utilise their dementia care training when supporting the patient. The unwarranted variations seen in practice were addressed by aiding staff to quickly identify those with additional support needs and thus deliver dementia friendly care quickly and efficiently at the point of contact.

What to change

Person-centred care recognises that an individual with dementia is still a person and deserves to be treated as a human being, rather than as an illness. Therefore, the senior healthcare assistant focused on providing the right care and support to those with dementia, particularly in their busy Emergency Department. By strengthening the focus of dementia care within the department, patient’s, family and friends feel they are more effectively supported with a continued focus on compassion, dignity and respect tailored to meet the patients specific needs.

How to change

The HCA undertook NCFE level 2 dementia care training to help her identify ways to ensure patient centred care for patients was in place. She then focused on developing current practice in the department such as adapting patients’ wrist brands so that any individual with a dementia diagnosis could be readily identified by staff and so that patients felt they weren’t alone. This was achieved by cutting a forget-me-not flower symbol into the patient’s wristband between a patient’s information and the barcode ensuring visibility of the symbol. Further work was undertaken with staff across the emergency and other departments within the hospital to notify them of the changes to the wristband and what the innovation was aiming to achieve. A dementia information noticeboard and diversion activities were also introduced to provide staff, patient’s, families, friends and carers with more information and resources to support dementia patients through their time in the department.  The adaptation was the quickly adopted by other areas of the hospital and is now utilised in other ward settings.

Adding value

• Better outcomes – The improvements aim to support person centred care for patients with dementia and to avoid any unnecessary distress during their stay in hospital. The impact of the improvements has been well received by patients, their families and carers as well as staff at the hospital. They have given qualitative feedback, rather than quantitative data, that they feel patients are treated with dignity and respect by the Emergency Department team.
• Better experience – There has been positive feedback from patients’, their families, friends and carers, as well as health professionals and the general public. Relatives in particular have express gratitude and relief that their loved-one’s dementia is made clear in such a discrete way.
• Better use of resources – The wrist band adaptation is low in cost and easily carried out, by simply having a small forget-me-not flower cutter beside the patient wrist band printer.

Challenges and lessons learnt for implementation

• The introduction of the noticeboard and diversion activity has been a positive addition for patients with dementia.
• A poster and cutter in the ED near the wristband machine is a useful reminder for staff to add the forget-me-not where necessary.
• Each wrist band adaptation has the potential to prevent distress through miscommunication throughout a patient’s hospital visit or stay.
• When implementing in a busy department, staff needed to remember to check the wrist band for the dementia indicator. It is therefore essential that the forget-me-knot is in a place where it can be easily seen.
• Simple diversion activities have a significantly positive impact, patients seem more relaxed and happier but it is important to find the correct diversion activity for each individual and not make assumptions.

Find out more

For more information contact:

• Allyson Rigby, Senior Healthcare Assistant, allyson.rigby@lthtr.nhs.uk