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Enhanced dementia care team of HCAs proving success after first year

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A team of healthcare assistants specially recruited to work with elderly and confused patients has eliminated falls and improved the quality of care.

Since the “enhanced care service” was introduced about a year ago at Burton Hospitals NHS Foundation Trust, none of the vulnerable patients cared for by the 10-strong team had suffered a fall.

“Each nursing assistant is allocated to the same patient consistently for as long as they need that care”

Julie Thompson

Meanwhile, junior doctors have been called out far less to deal with patients in distress and there have been vast improvements in the continuity of care and overall wellbeing of patients, according to an internal evaluation.

The service, which involves a “virtual ward” of nursing assistants providing one-to-one care for patients with dementia, was instigated by lead nurse for older patients Julie Thompson.

She said previously bank and agency nurses had been used to provide one-to-one care, but with a “cost attached” and “no consistency in the delivery of that care”.

“It would be a different nurse each shift and, if a patient moved wards, it would be a different nurse again,” she said in an interview with Nursing Times.

After having her business case approved by the trust’s board, she recruited 10 HCAs, who received specialist training in dementia care and managing patients in distress.

“They sit in a virtual ward with the dementia team and are allocated on a weekly basis to patients that require an enhanced level of care,” said Ms Thompson.

Queen's Hospital, Burton

Queen’s Hospital, Burton

Queen’s Hospital, Burton

“Each nursing assistant is allocated to the same patient consistently for as long as they need that care, which helps them build up a relationship with that patient and also their family and carers.”

Ms Thompson said the role was appropriate for HCAs who underwent an innovative selection process, which included group work and being observed watching a short film about the experiences of a patient with dementia in hospital.

She added: “I don’t think it is a registered nurse role. This is about delivering the fundamentals of care and engagement with patients and fits well with the skills of nursing assistants who get ongoing education.”

The team was launched in late December last year and Ms Thompson has been evaluating the difference it has made through feedback from ward managers, medical staff, families and carers.

“Ward managers report the continuity of care has improved because the service follows the patient and that has been particularly noticeable when patients move from the assessment unit to a ward, which can be disorientating,” she told Nursing Times.

“Senior nurses also say they feel much more confident about the quality of care being delivered, whereas before they had to keep checking and there has been a notable improvement in interaction with patients,” she said.

“When we used bank and agency staff they would sit by the bed but not engage with patients,” she said. “Now our enhanced care team use the activity boxes we have on the wards to play dominoes or read to patients, paint their nails – whatever it takes to keep them engaged, occupied and stimulated.”

In addition, an audit of record-keeping has shown a marked improvement in the quality of observations and overall standard.

Meanwhile, junior doctors have reported a huge reduction in the number of times they are bleeped to attend dementia patients.

“All the junior doctors – without exception – said the number of bleeps for a patient was significantly reduced when an enhanced care team member was with that patient,” said Ms Thompson.

“Previously a junior doctor would be bleeped as soon as a patient started to get agitated and they were struggling to cope with demand, whereas that is not happening anymore,” she said.

“We were very clear that even if a patient was asleep and whatever else was going on they were not to leave that patient’s side”

Julie Thompson

Since the service was introduced the trust has also seen a reduction in the number of “deprivation of liberty” referrals it needs to make because patients are more settled with their cognitive function boosted by interaction.

A survey of carers found all were very happy with the care their relatives received. One woman who did not feel able to leave her elderly mother said she now felt confident in taking a break and going home.

Ms Thompson said one of the most striking differences was the fact falls had been reduced to zero among this high risk group.

She said one reason for this was team members were told to stick with their patient no matter what – which did cause some problems at first.

“We were very clear that even if a patient was asleep and whatever else was going on they were not to leave that patient’s side, as they were there to enhance that person’s care and not part of the numbers on the ward,” she said.

“That is one of reasons we have had no falls as patients who are asleep can suddenly wake, get up and fall,” she said. “It was a bit of a barrier at first but we have overcome it and people see the benefit now.”

The service has saved significant amounts of money reducing spend on bank and agency nurses by about £60,000 a year.

Meanwhile, the trust has been working with others, including University Hospitals Coventry and Warwickshire NHS Trust, to help launch similar services.

The enhanced care service is among a number of innovations in elderly care introduced at the Burton trust in recent years.

The HCAs are now spearheading work to capture and document the experiences of patients with cognitive impairments to help further improve care – using the Kinda Magic observation tool developed by Peninsula Community Health in Cornwall.

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Readers' comments (1)

  • As a bank HCA, I can confirm that we, bank HCAs are systematically used and abused into doing 1:1 observations for the whole shift (7 hours or 13 h for long days) with people with dementia who keep pulling on their catheters or stand up and try to walk when they can’t actually walk etc etc...
    Most of us absolutely HATE doing it!
    We are totally isolated from the rest of the team, we just sit on a chair all day with nothing to do other than ‘please sit down sir’ or ‘please don’t pull of that tube’ etc...
    Sometimes, we have to look closely not at 1 but 2 or even 3 confused patients with no support from the permanent staff whatsoever. When we seek support, too many times we receive a reluctant reaction from the permanent staff like ‘get on with it’. Disgusting!
    It is very convenient for the permanent staff to shove us in a bay on a those “specials” and forget about us!
    This is total punishment and as a result, the bank office is a sinking ship because unable to cover shifts as most of us are sick of being treated like second class employees and no longer pick up shifts.
    Doing 1:1 for hours together without the possibility of taking turns with other HCAs is a punishment for most of us!
    I now just pick shifts on outpatient or discharge lounge to stay away from the wards. Best practice would be taking turn every hours so to be fresh headed when sitting with the patients.
    Is this going to change? Nope. No one cares!

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