Wednesday, 3 May 2017

Overview of our Work on Improving Care

Influencing the delivery of care for people with dementia in acute hospital wards 

My work has a strong focus on improving the quality and humanity of care and providing the empirical foundations for developing low-cost interventions and training. So I am currently developing interventions to influence the delivery of care at ward level and currently piloting a ‘bundle of care’ in acute wards within one Hospital Trust.

I am collaborating with a ward team and the Chief Executive, Executive Director of Nursing, the Head of R&D, and the Dementia Board within Aneurin Bevan University Health Board, South Wales. The goal of the pilot is to test interventions to improve care that are scaleable and can be used in other wards and hospitals.

Why now? 

• People with dementia are one of the largest populations cared in general acute hospital wards (they are not typically in specialist dementia or care of the elderly wards).

• They occupy 1 in 4 acute hospital beds at any one time (Alzheimer’s Society, 2009) and 3.2 million bed days per year (Department of Health).

 • This may be an underestimate, with some acute hospitals reporting that 40 to 50% of their patients have dementia (Alzheimer’s Society, 2016). This reflects the high rate of undiagnosed dementia.

• This group are not in hospital because of their dementia- but for an unrelated condition- infection, fractured hip, dehydration.

• They are not at the late stage of their dementia diagnosis and so should survive and be discharged, however, 1 in 4 die during their admission

• They are a highly vulnerable group and if they survive, admission causes malnutrition (80%), incontinence (47%), and loosing skills (needing help at meal times (49%)) which may mean they cannot go home.

• They are the group most at risk of delayed discharge – lengthy hospital stays when they are medically fit to be discharged but social care is not in place to enable this.

• This is an increasing population, which means that this issue will only become more pressing to a service with limited resources.

 • In an age of austerity, low cost or no cost solutions are required- culture and organization of care is key.
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