Our Quality Account - have your say!
The second group relates to patient experience.
Please click on each of the titles below to learn more about our patient experience priorities, and then vote for which of the four you think we should prioritise. Once you have voted you will be taken to the next category.
We would like to change the thinking culture around food and fluid management for Dementia Patients on our wards. A ‘Dementia Friendly Environment’ is an objective included in the Dementia Care Strategy for ESHT, to ensure that environmental improvements are continually made to improve the quality of care for patients in a well-designed dementia friendly environment. We wish to explore patient preparation prior to mealtimes, for example, using the toilet and personal care routine to also support the overall mental wellbeing of our patients.
It has been highlighted on the wards that Dementia patients are often not eating and drinking the required amounts, therefore increasing the risk of patients becoming dehydrated, constipated and experiencing delirium.
The dining experience and quality social interaction is such an important element of basic patient care, we have noticed that a patient’s social skills can decline whilst being an inpatient, which can in turn have an impact on the length of stay in hospital.
Our aim is to make dining a time that patients look forward to, that they enjoy – this is a time for patients to build upon their social skills and start to eat and drink again as they once did. Patient’s must be given a choice as to what they want to eat and not feel intimidated or rushed. We will be providing the specialist DIET Training to all staff that are involved in a patient’s care.
We were advised that Training to Care had a course that they delivered to care homes around food and fluid management with dementia patients, we felt that this course could also benefit a hospital setting if it were to be adapted appropriately.
This course could make a significant difference to a patient that has dementia or a cognitive impairment.
Staff who attend the new DIET course will expect to see some PowerPoint learning but also some experimental training which will allow them to step into the shoes of someone with a cognitive impairment or dementia. Our aim is to train all ward-based staff including housekeepers in the first instance – making sure that all documentation is accurate, factual and up to date.
Staff will complete staff surveys before and after attending the course to look at staff confidence, patient intake and staff motivation.
Food and fluid charts – assessment, compare completion before and after a staff member has undergone training.
Bowel Charts – assessment, compare completion before and after a staff member has undergone training.
Drug Charts – assessment, better food intake should reduce the need for laxatives and enemas.
Our hope is that there will be less of a need for patients to be given fluid via IV therefore reducing the costs overall and any distress this may cause a patient.
Verbal feedback from patients/family (discussions with patients and their families to obtain a measure as to how they feel that the project has been going and to see if the patient experience has been enhanced).
Social skills observed including wellbeing (surveys given and collated to provide a simple overview of how people are feeling and feedback from this, comparing the before and after experience – this would include feedback from all professionals involved including Physiotherapy, Occupational Therapy, Speech and Language Therapy, Dietitian and ward staff).
The National Audit of Dementia measures the quality of care for people with Dementia whilst in hospital. The audit measures (amongst many other things) whether inpatients with Dementia have a bedside document with up-to-date person-centered information included, this is known as the ‘Reach out to Me’ document and provides an insight into the patient’s preferences and life history.
Dementia is a syndrome of brain decline which affects memory, thinking, language, mood and behaviour. When a patient is admitted with Dementia, their surroundings can often feel confusing, and the patient may not fully understand why they are in hospital or what is currently happening. The Reach out to Me document is available for patients and carers to update with information such as what makes the patient anxious and what calms them down, as well as likes and dislikes and routine insights to support the staff in the hospital to know how best to care for their individual needs.
Recent local audit activity has shown that unfortunately Dementia inpatients do not always have this bedside documentation with them which can then negatively impact the quality of their experience and care whilst in hospital.
We want to address these results – reviewing documentation availability, booklet location across the wards, addressing any knowledge gaps and awareness barriers in relation to the benefits and use of the documentation and improve the quality of care for these patients.
Carry out a quality improvement project to look at the following:
Relaunch the document and highlight its importance for Dementia patients.
The national audit of care at the end of life (NACEL) is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the last admission leading to death in acute hospitals. It is a mandatory requirement for East Sussex NHS Healthcare Trust (ESHT) to review case notes of patients who are at the end of their life in hospital to review the quality of care provided to the patient and carers.
NACEL highlights the importance of recognising when a patient is at the end of life, and this being reflected in the case note review. It has been noted from NACEL data (2024) that dying is recognized (and/or acknowledged) significantly later in ESHT hospitals compared to the national average.
The End-of-Life Care (EOLC) improvement group set a target that 90% of deaths would be anticipated / expected, this audit has shown that we have not reached this target, although there has been some improvement as the year progressed. This is particularly the case for Conquest Hospital where 83% of deaths were anticipated and is above the national mean average of 80%. Recognition was poorer at Eastbourne Hospital with 78% of deaths anticipated. On reviewing the notes, it often was clear that the patient was deteriorating much earlier in their admission but was not formally recognised.
Of those patients whose death was not expected, we also didn’t always recognise that they were ‘sick enough to die’. Being ‘sick enough to die’ is when a patient is deteriorating, clinically unstable with limited reversibility and at risk of dying during the episode of care despite treatment. For NACEL this would include documentation that the patient may not survive this admission.
Previous NACEL audits have consistently demonstrated that dying is recognised very late with little time to prepare patients and those closest to them. There was an average of 2.5 days at Conquest and 2.32 days at Eastbourne from documented recognition of dying to death, compared to 4.79 days national sample. But the timeframe ranged from less than an hour to 7 days.
Education for all clinical staff in the need to recognise dying at an earlier stage in a patient’s care. We would like to provide bespoke consultant to consultant training around this for senior clinical decision makers in the trust. We plan on relaunching the Supportive and Palliative Care team with referral guidelines and referral form planned for April 2025.
This is an opportunity to improve patient experience of care with a single community or ‘step-down’ offer from hospital.
Patients do not need to be on one waiting list or another to get the support that they need to go home and this could be avoided with a ‘one team’ approach with the patient at the centre with the planning based on patient needs.
This one-team approach would improve the clarity of the delivery model (not multiple different service criteria), it would reduce duplication of referrals and wait times and should release capacity in community services. There would also be a reduction in community deconditioning and increased risk that is evident in long waits to access community services, which then impacts on risks of readmission or secondary complications.
Development of a single integrated Intermediate Care service (including our community beds and wider community services) with a Single point of access to ensure that we match the right clinical and care skills to support patients to get home. This would be an integrated approach with Urgent Community Response, Virtual Wards, community therapy including Stroke and our Uni-Disciplinary services (Speech and Language, Dietetics and Podiatry services). There would also be an opportunity to include Adult Social Care and Reablement services as well as our Community Voluntary sector partners.
The integrated Intermediate Care service could also support both in-reach and out-reach care to best meet patient needs.
