Improving services in specialist dementia units

Focus on Dementia, our national improvement programme for dementia, has been working with four specialist dementia units across Scotland to support improvements in the quality and experience of care, and to share the learning through a network of practitioners across Scotland.

One of the four demonstrator sites for this work is Prospectbank in Finlay House, within Edinburgh HSCP. Prospectbank is a 30 bedded specialist dementia unit managed by the Hospital Based Complex Clinical Care (HBCCC) services. People are admitted for care and treatment for symptoms related to a diagnosis of dementia.

Prospectbank used the experience based co-design (EBCD) model to help them  identify improvement priorities relevant to their local context. A range of participatory approaches, including patient observations, interviews with carers and staff, and co-designed events were undertaken. These identified the areas for improvement that mattered most to people with dementia, carers and staff. Care for Carers, a local charity helped to gather feedback from a range of relatives and carers.

Evaluating the use of EBCD, one staff member observed, “This process has challenged my assumptions about what I thought carers and people with dementia wanted.”

Key improvement priorities were identified as:

  • Increasing meaningful person centred therapeutic activity.
  • Reviewing the environment to make sure it is dementia friendly.
  • Improving the mealtime experience.

Tackling the latter priority, a mealtimes improvement group was set up, which included representation from Food for Life, a programme run by the Soil Association, promoting access to good quality food and Artlink, a local charity promoting access to the arts to support positive change.

Observations highlighted that the mealtimes were very noisy and having a negative impact on patient experience.

Prospectbank staff tested out simple but highly effective changes, including replacing the metal utensils with silicone utensils to reduce noise levels. They also moved any non-food-based activities to another location to make mealtimes a focused, more pleasant experience.

“Working with people on the unit and carers means we now understand what will really make a difference, said Caroline Lawrie, Clinical Services Manager.

“Without the time invested up front we would have been doing the wrong things. The ward team have already been able to demonstrate an impact around improving the meal time experience.”

The improvement group is now planning further improvements, including reviewing the menu and looking at improvements to the environment and how the space is used at different times of the day.

This work and other examples of improvements in practice in specialist dementia units will be shared through our forthcoming regional network events in the year ahead.

We are actively working with the Scottish Executive Nurse Directors to agree how best to spread the good practice across Scotland.