Outcome 5. Care environment
People with dementia are cared for in a safe and supportive, dementia-friendly environment that enables them to be as independent as possible while retaining links with the external environment.
The boards demonstrate wide understanding of the importance of positive, stimulating and safe environments to support people with dementia and their carers, and many innovative initiatives are underway.
They generally have in place standard facilities that help to improve care environments, with appropriate signage, contrasting colours on walls and furniture to help define space, access to safe garden spaces, quiet areas in wards where patients can relax, and single, personalised en-suite bedrooms being common features. Chaplaincy and access to church services are also available across boards.
The NHS Grampian Older Adults Mental Health Environmental Group meets on a monthly basis and is in the process of developing six-monthly environmental audits that will cover estates work, appropriate escalation procedures and promotion of dementia-friendly environments. The work will be supported by NHS Grampian's four dementia design auditors.
Dementia design auditors are also in place in other boards. In NHS Ayrshire & Arran, for instance, three members of the Elderly Mental Health Management Team have trained at the Dementia Services Development Centre at Stirling University. They provide advice, assistance and expertise on creating dementia-friendly environments within existing environmental constraints. They also advise on how telecare can be used to promote independence for people with dementia while in hospital. Similarly, NHS Forth Valley is one of several boards that use the Dementia Services Development Centre environmental audit tools to assess clinical areas. An auditing programme is being implemented and a number of areas have developed action plans, with many environmental improvements being precipitated by the audits.
More generally, the Dementia Services Development Centre has been involved in staff training and the structuring of many wards, including the Prosen Unit, a custom-built dementia facility in NHS Tayside. The board has trained 22 staff in elderly mental health units and community hospitals on dementia care-mapping, which is now featuring across most of the board's mental health wards for older people. Staff members in NHS Lanarkshire have influenced the board's Facilities and Estates Department to consider and incorporate dementia design into its planned maintenance programme, and together they have designed and developed a dementia ward specification.
Other audit tools have also been used. A ward in NHS Lothian, for instance, carried out a self-audit using the King's Fund Enhancing the Healing Environment (EHE) environmental audit tool. The EHE ethos is that small and inexpensive changes can have significant impacts. As a consequence of the audit, the ward took steps to improve the height of signage, provide more signage to help patients identify their bedrooms, and give more consideration to the presentation of patients' food and drinks.
Safety is a priority across all boards, but there is also a recognition of the need to adopt risk-enablement approaches to enhance patients' independence and freedom. In NHS Greater Glasgow & Clyde, for example, community time out of the ward is regularly planned as part of ward activity schedules and is included in individual care plans (following risk assessment and, where appropriate, discussions with patients and carers). This approach is enabling patients to take part in previously enjoyed community activities, such as visiting a local chip shop for a fish tea, or just enjoying walks in well-known places. Patients in NHS Grampian's wards are encouraged to be as independent as possible while physical safety is maintained through use of appropriate equipment, such as hip protectors, walking aids, protective mats and bed sensors to promote freedom and minimise risk. The units use environmental observations to allow freedom of movement while maintaining safety.
Occupational therapists and activity coordinators provide structured meaningful activity in wards in many boards, with some, including those in NHS Greater Glasgow & Clyde, also actively involving third-sector and voluntary organisations to provide support and assistance to patients and carers. Many boards use life-story or "Getting to Know Me" documents to help staff identify how they can support people to maintain their meaningful community activities and relationships. NHS Highland has been participating in a pilot scheme using the Elderflowers programme, which has a specific focus on engaging with older people with dementia.
Innovative work in relation to developing musical playlists for patients on iPod or similar devices is being taken forward by boards such as NHS Ayrshire & Arran and NHS Fife, supported in some instances by equipment donated by carers. One patient in NHS Lothian had been supported to use an iPad to communicate with staff.
Email: Ian Roxburgh
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