Patients with dementia are being given few opportunities to have drinks of water on wards and in accident and emergency, which is leaving them “extremely vulnerable”, a review of London hospitals has found.
The review of dementia care on wards and in emergency departments at six of the capital’s acute trusts was carried out by nursing leaders over the summer. It focused on nutrition and the involvement of carers within 48 hours of admission.
“It is imperative that people with dementia in hospital receive adequate nutrition and hydration”
NHS London dementia clinical network report
The senior nurses, who peer reviewed care at other hospitals within the group, found it was not uncommon to see patients without fresh water or cups in reach.
In some cases, patients had no water jugs at all – and staff had failed to notice or address the issue, said a report on the review, which was shared with Nursing Times.
“Patients were seen without any water cups and water cups out of reach; these patients were not able to ask for a drink or ask for help and were therefore extremely vulnerable,” said the report.
Meanwhile, it noted that staff on one ward were not aware that two of their patients had dementia, despite the information being included on the handover form.
In A&E, leftover food and cups of tea that had gone cold were noted as a “particular issue”, according to findings from the review, which was set up by NHS England’s dementia clinical network in London.
“Carers can play a key role to support this, but many people will not have a carer with them”
NHS London dementia clinical network report
While ward meal times were well supervised, few patients were supported to drink outside of these periods, said the report – titled Nutrition and Carer involvement for people with dementia in hospital (see attached document below).
Patients also appeared to have not been asked about their preference for using either a cup, beaker, or beaker with lid, it highlighted.
Due to staff shortages in A&E, unless volunteers were on hand, it was sometimes not possible for patients’ hydration and nutritional needs to be “adequately” met, stated the report.
Volunteers were generally found in elderly care departments and not in emergency departments, it said, also noting that most patients with cognitive impairment arrived at A&E without any relatives to support them.
“It was good to meet so many committed nurses, therapists and medics championing and caring for people living with dementia”
However, the network found the majority of hospitals had signed up to a campaign calling for relatives to be able to visit patients with dementia both in and outside of normal visiting hours, and carers were encouraged to help patients eat and drink.
Staff on wards were enthusiastic and there were good examples of leadership across the hospitals, such as one clinical expert championing open visiting, said the network in its report.
Those behind the review stressed they had witnessed “excellent” care, particularly by nurses, but said trust chief nurses needed to address problems with patients having little access to drinks outside of meal times. They also stressed the fact most patients with dementia were attending A&E unaccompanied.
“It is imperative that people with dementia in hospital receive adequate nutrition and hydration. This needs to be considered 24 hours per day and throughout the hospital, including the emergency department and be personalised,” said the report.
“Carers can play a key role to support this, but many people will not have a carer with them, therefore other forms of support need to be in place,” it added.
“We are pleased that the London directors of nursing are using the learning from this to improve care”
Professor Siobhan Gregory, NHS Improvement’s quality improvement director for North West London, is leading the dementia network’s acute programme and helped to set up the review.
“It was good to meet so many committed nurses, therapists and medics championing and caring for people living with dementia and their families,” she told Nursing Times.
“The audit highlighted some areas of good practice, including dedicated teams of healthcare assistants using memory aids to support patients across the trust and the use of volunteers in emergency departments to support nutrition,” she said.
“The kindness and compassion shown to patients and their carers was excellent and we are grateful to the trusts involved for participating,” she said. “We are pleased that the London directors of nursing are using the learning from this to improve care.”
Trust chief nurses were now supporting the next stage of the work, which would investigate delayed transfers of care for people living with dementia, added Professor Gregory.