Case study summary
Key learnings identified by the CNO National Shared Professional Decision-Making Council:
- Individualised care planning is the foundation of good dementia care with additional measures including dementia specialist nurses and MDT working.
- Communication between clinicians and carers remains paramount
- The importance of deploying assessment and decision-making tools to shape and support dementia care.
- An individualised approach can help to enhance the discharge process and ensure the right support is in place within the community.
Background to learning
As public awareness and professional understanding of dementia continues to advance, health and social care teams remain focused on improving personalised support for those with dementia whether in hospital or at home.
Whilst progress has been made, people with dementia can experience increased inpatient admissions and lengths of stays. They can also face challenges such as an increased likelihood of discharge to care homes, prescription of anti-psychotic drugs, increased risk of delirium and increased fragility during the pandemic due to isolation. During the pandemic, CNO National Shared Professional Decision-Making Council members recognised the need to ensure now more than ever that those with dementia were cared for in the right place, at the right time and by those with the right skills.
Learning and advice to be shared
Council members reflected that individualised care planning was the foundation of good dementia care. This approach recognises that what might be right for one person may not be right for another and supports those giving care to look carefully at how the right care can be ‘wrapped around’ the person and their families/carers.
Council members reflected that, in addition to this, other measures had worked particularly well in their practice during the pandemic:
- Assignment of a dedicated named health professional contact for each patient to ensure a coordinated approach to care
- Ensuring multi-disciplinary working by making the best use of expertise including dieticians, Speech and Language therapists and the use of the relevant specialist services for end of life care, pain management and mental health support.
- Adopting approaches to help identify those with additional support needs such as colourful butterfly emblems or daisies.
- Dementia specialist nurse roles were also recognised for their role in helping lead, deliver and coordinate relationship centred care in order to help improve the experience of carers/families affected by dementia and to support specialised education, training and support for staff.
Council members also noted how during the pandemic communication between clinicians and carers remained paramount and highlighted a number of ways to support frequent discussions with relatives about care and planning:
- Keeping an informal diary for each person’s family to use and input into.
- ‘Passport’ systems to help ensure familiar contacts were developed in collaboration with patients, their families and carers as well as staff who supported them. This helped to deliver personalised care for people with dementia whilst ensuring infection control regulations were adhered to.
Council members also identified the importance of the use of tools to support care with many teams deploying assessment and decision-making tools to shape care. These include:
- Delirium Assessment Tools being introduced in critical care to provide a baseline and enable forward monitoring has been recognised as being helpful with individuals with cognitive impairments and dementia.
- Encouraging the completion of the ‘This is Me’ document on admission to help healthcare professionals get to know their patients and thus provide individualised patient centred care.
- Cognitive assessments formed the basis of referral to a specialist delirium and dementia outreach teams available within Trusts to offer support to ward staff through the assessment and support for patients, their families and carers.
Would it be beneficial to retain these changes?
Council members reflected that these areas of adaptation support a continued focus on the holistic needs of an individual and would help Trusts to continue to build the right teams to support the physical and mental care need of in people with dementia.
Approaches such as ‘passporting’ have been vital in supporting the wellbeing of patients and also enable closer working between professionals and carers. Getting an individualised approach right while a person is in hospital can help to enhance the discharge process and ensure that the support people with dementia need from multi-disciplinary teams in the community is in place for them.
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