Transcript Malvern, a ward for people with dementia in an acute Trust

Malvern, a ward for people with
dementia in an acute Trust
Judy Haworth
Speciality Doctor in Dementia Care
North Bristol NHS Trust
Environment
• 18 beds with 5 side rooms
• Day room, calendar board, clock, nurse presence to
ensure safety, good for intentional rounding and activities
• Dining room, all meals here, snack dispenser, bright
light, looks onto garden, bird feeders
• Good lighting to reduce shadows
• Plain floor throughout
• Coded doors to protect charts, notes /
treatment room/ kitchen/ teaching room
Environment
This a closed ward with locked entrance
door, garden gate, restricted opening of
windows, all fire exits alarmed
There is usually free access to the
garden, weather permitting
Doors are locked to make a safe area
rather than to control people
Dining room tables
Coloured crockery routine,
no clear glasses,
Use coloured liquids rather than
Water
High quality lighting to reduce
shadows
Signage is in words and pictures and
colours.
Nursing routines
• Aims to protect and encourage a daily
routine
• People are in their own clothes
• They eat in a dining room
• Unless infection control intervention
necessary they are in a communal/social
environment during waking hours
• Walking to day room and dining room
Nursing routines
• Activities provided, music, vol to talk to people,
newspaper, aromatherapy, massage, skittles.
• Intentional rounding
• Excessive fluid rounds (13)
• Staff better able to monitor and assist with
nutrition in the dining room, snacks
available
• More honest medication compliance,
photos on drug charts
Medical interventions
• Review of all diagnoses / mood
• Access to liaison service if needed but inhouse expertise
• Use of antipsychotics minimal
• Cholinesterase inhibitors used freely with
more rapid titration
• Memantine
• Junior doctors given training in diagnosing
and managing dementia
Improvements
• Bigger day room with “zones”
• Larger bedrooms for palliative and end of
life care
• More activities
• Bright “day lights” in dining area
• Aromatherapy
• How to entrench the use of “This is Me”
• More rotation of staff through the ward