How an enhanced care initiative has improved dementia services
Introduction of an enhanced nursing care team has reduced use of costly support staff
Introduction of an enhanced care team has reduced use of costly support staff
The number of people with dementia is expected to double worldwide over the next two decades. In the UK alone, it is estimated there will be more than 2 million people living with dementia by 2051.
At East and North Hertfordshire NHS Trust, we have therefore made providing high-quality care for patients with dementia a priority.
In 2016, we set up an enhanced dementia support team (EDST) to provide one-to-one support for patients with dementia or delirium who are a risk to themselves or others.
The EDST is available 24 hours a day, seven days a week, ensuring that patients who cannot maintain their own safe environments are always supported by specially trained staff. The team is made up of a band 8 matron, a band 6 service coordinator and 17 whole time equivalent band 3 clinical support workers.
Previously, one-to-one care was provided over 12-hour shifts, which meant staff had to concentrate on one patient with complex needs for a long period of time and patients were not being offered the variety of stimuli they required. Now, we use software to divide each 12-hour shift into three-hour blocks allocated by the service coordinator on the day before. These shorter blocks reduce monotony for patients and help staff to care for patients with the greatest need.
Daily ward round
We have also introduced a daily ward round carried out by a senior team member who reviews behavioural charts and talks with patients, carers and staff to ascertain if one-to-one care is required.
We can rate wards as red, amber or green by looking at patient numbers and acuity, and staff can be moved around the hospital according to the greatest need. Any changes during the day, such as admission or discharge of patients needing enhanced care, are flagged to staff by mobile alerts.
Volunteers work alongside the team. We have given the volunteers dementia training and can allocate them to patients who need someone to talk with them or help them with everyday tasks such as eating.
Before we introduced the EDST, we employed costly agency support workers, who had little experience of caring for people with dementia. By creating a specially trained team, we can ensure patients are cared for by staff who have learned therapeutic techniques to keep people with dementia calm and settled.
The EDST has been so successful that we have expanded it to cover patients who are confused or at high risk of harming themselves or others, and have renamed it the enhanced nursing care team (ENCT).
All requests for enhanced care must go through the ENCT, which means resources are spread more efficiently across the hospital. The team has enabled us to save around £45,000 per month by using substantive staff rather than agency staff.
The introduction of the team has improved the quality of care and patient experience. It has also improved patient safety, including helping to reduce the number of falls.
We have had a great deal of positive feedback from patients, carers and staff about the ENCT – it has made a real difference to the care our vulnerable patients receive.
About the author
Emily Watts is a safer staffing matron, East and North Hertfordshire NHS Trust, Stevenage