Adapted ‘This is Me’

Name: ____________________________ Unit no. _______________

I prefer to be called_________________________________________

When using a person-centred approach, it is vital to think about people’s needs and difficulties in the context of their life.

This information can be completed by multidisciplinary team member, family, friends and carers. It won’t be completed in one sitting but will build up a picture of someone’s life, personality, likes and dislikes.

The questions included in this form are not exhaustive but are examples of things to ask to try to get to know the individuals’ preferences. Areas important to ask about include:

Daily Routine

Family and friends

Important people in my life

Important places

Education, school and work

Hobbies and interests

Beliefs

My personality

Favourites

Special memories and stories

Important dates

DAILY ROUTINE

What like do you like to get up in the morning and what time do you like to go to bed?

………………………………………………………………………………………

Do you like to get up straight away or do you prefer to lay in bed for a while?

…………………………………………………

Burton Hospitals

NHS Trust

Carers Experience Survey

Ward: Date:

This hospital recognises that carers and relatives play a vital role in the care of patients with dementia and is committed to improving how we work with and support carers of our patients. This survey is about your experience of the support provided to you during your relatives stay at our hospitals. Please complete this survey as fully as possible. Your responses will be treated confidentially and will be used to improve how we work in partnership with carers.

AdmissionQ1 During the admission assessment did staff ask you for your input?

Yes, a great deal Yes, to some extent No, not at all I can’t remember

Q2 Were you provided with the “This is me” document?

YesNoI can’t remember

Q3 Were you asked how much involvement you would like with your relatives care whilst in hospital.

YesNoI can’t remember

Important facts you should know about

dementia

people with dementia, and they shape person-centred care.

1. Comfort People living with dementia may have a sense of loss, causing anxiety and insecurity. They need an environment of comfort and empowerment.

2. AttachmentThe need for attachment is strong in each of us, more than ever when we feel like a stranger in someone else’s environment. People with dementia need to feel a sense of belonging.

3. Inclusion

be included in situations where others do not have the same impairment. Individualised care and physical settings help people feel they are part of a group.

4. OccupationBeing occupied means being involved in everyday life. Carers and designers need to create conditions that support social involvement, drawing on people’s experiences, strengths and abilities.

5. IdentityA person with dementia is unique. A person’s life-story should be built into all interactions in the hospital setting i.e. use of ‘This is me’ document.

Fundamentals of Care

Fundamentals of Care view the

in the development and promotion of best practice and quality services. On a personal basis the relationship between the patient and care provider is fundamental.

The relationship between the person giving care and the person receiving care should be a partnership. Everyone is an individual and should be treated according to their needs and wishes. Patients should receive the highest quality of care and we have a responsibility to provide this.

For further information and advice please contact:

Alison Haynes, Lead Nurse Dementia 01283 511511 ext 5206 bleep 265

With thanks to the Alzheimer’s Society in

CORP/CQIN/0010/0312Creation date: March 2012Review date: March 2014

Dementia is not a natural part of ageing

When someone voices fears about becoming forgetful or confused, people often reassure them that it is a normal part of ageing. But are they right?

It is true that dementia is more common among the over 65’s, and some of us do become more forgetful as we get older, or during time of stress or illness.

Dementia is a different sort of forgetfulness. Many of us may momentarily forget a friend’s name, but if you have dementia, you may forget that you have ever met them before. Your memory loss will be more noticeable and may be accompanied by mood changes and confusion.

Forgetfulness and confusion are not always signs of dementia, but it is important for the person to have the cause investigated. Drugs are available that can help people with certain forms of dementia. Other medication can help with symptoms that often accompany dementia, like anxiety or insomnia, so it is always better to inform a member of the medical team if you are concerned.

If the person does not have dementia the forgetfulness may indicate another condition such as delirium or depression; both need to be investigated and treated.

Dementia is caused by diseases of the brain

Dementia is the name for a collection of symptoms that include memory loss, mood changes and problems with communication and reasoning. These symptoms are brought about by a number of diseases that cause changes in the brain. The most common of these is Alzheimer’s disease.

Alzheimer’s changes the chemistry and structure of the brain, causing the brain

short term memory loss. Other types of dementia include vascular dementia, dementia with Lewy bodies and Pick’s disease.

Each of these diseases affects the brain in slightly different ways. For example, Alzheimer’s disease tends to progress

tends to progress in a stepped way.

A person’s experience of dementia will depend on other things; the people around them, their personal circumstances and the environment. Dementia progresses in a way that is unique to each individual.

It’s not just about losing your memory

People always think of dementia as a form of memory loss and usually it does start by affecting people’s short term memory, but it is more than that, it can also affect the way people think, speak and do things.

Dementia makes it harder to do things

learn new activities. Dementia can also make it harder to communicate.

Dementia also affects people’s mood and motivation levels. This may happen if the disease affects the part of the brain that controls emotions, even where this does not happen, people with dementia can feel sad, frightened, frustrated or angry especially in an acute hospital environment.

Dementia cannot be cured but there is so much we can do to improve the persons experience in Burton Hospital’s NHS Foundation Trust.

Developments in caring for patients with dementia- our commitment to our patients

DementiaInformation and

advice for people with dementia and

their carers

IMPORTANT!

If you do notice increased confusion in the person you care for please inform the nurse or doctor immediately. This may be related to a progression in dementia but it could also mean an underlying medical problem that we may be able to treat. This medical problem is often described as ‘delirium’.

It may be possible for a carer to help with care ( for example, support with eating and drinking) If you would like to do this please contact the nurse in charge.

Other ways to help may include:• Cleaning spectacles and checking hearing

aids• Making sure clothes are discreetly

labelled in case they are mislaid• Thinking of enjoyable hobbies to occupy

the person’s time

Many wards have visiting hours, however we understand you may wish for a relative or carer to be with you out of these hours. The Familiar objects such as photographs of family members or pets can be reassuring in an unfamiliar environment. Nurse in Charge will be happy to arrange this for you.

We acknowledge that some people with dementia may require extra support at mealtimes. All wards support ‘protected meal times’ where patients can enjoy their meals with minimal interruption. Completion of ‘This is Me’ can identify likes and dislikes and whether prompts to eat are required or if

If you notice the person you care for is not eating well, please inform the nurse in change so we can refer to the Dietician for advice.

Medication

Please bring any medication into hospital. This can help the doctors when admitting the patient to ensure their regular medications continue.

Discharge

A discharge date will be planned for you or your relative as soon as possible. However decisions can often be made quickly so please begin preparations as soon as the person is admitted to hospital. To help prepare for discharge you may see a Physiotherapist, an Occupational Therapist and a social worker. This team along with Nursing and Medical Staff will help plan a safe and supported discharge.

For further information and advice please contact Alison Haynes, Lead Nurse Dementia 01283 511511 ext 4738 bleep 265

xxxx/xxxx/xxxx/0313Creation date: March 2013Review date: March 2015

Introduction

Burton Hospitals NHS Foundation Trust, with the support of the Trust’s Dementia Operational Group have produced an

dementia and their carers. We hope this will help you to understand more about dementia as well as providing some useful information to ensure you or your relative’s stay in hospital is as comfortable as possible.

Dementia is caused by diseases of the brain

Dementia is the name for a collection of symptoms that include memory loss, mood changes and problems with communication and reasoning. These symptoms are brought about by a number of diseases that cause changes in the brain. The most common of these is Alzheimer’s Disease.

Alzheimer’s changes the chemistry and structure of the brain, causing the brain cells

memory loss. Other types of dementia include vascular dementia, dementia with Lewy bodies and Pick’s disease.

Each of these diseases affects the brain in slightly different ways. For example, Alzheimer’s disease tends to progress

tends to progress in a stepped way.A person’s experience of dementia will depend on other things too- the people around them, their personal circumstances and the environment. Dementia progresses in a way that is unique to each individual.

It’s not about just losing your memory

People always think of dementia as a form of memory loss and usually it does start by affecting people’s short term memory. But it is more than that, it can also affect the way people think, speak and do things.

Dementia makes it harder to do things

new activities. Dementia can also make it harder to communicate.

Dementia also affects people’s mood and motivation levels. This may happen if the disease affects the part of the brain that controls emotions. But even where this does not happen, people with dementia can feel sad, frightened, frustrated or angry especially in an acute hospital environment.

Being admitted to hospital

Hospital environments can be disorientating for a person with dementia and they may appear more confused than usual. However, there is so much that can be done to help a person with dementia adapt to a new environment.

Ward staff are happy to answer any questions and discuss any issues you may have. If at times they seem too busy to talk, please do ask to make an appointment with the doctor, Ward Manager or a member of the dementia team.

Information about the person with dementia

How people cope with dementia will be unique and individual to the person. It is really important that staff are aware of how dementia affects the person and in particular how their behaviour may indicate certain issues (such as being in pain).

In emergencies information in hospital may seem to only focus on the medical needs of the patient. It is very useful for a relative carer or friend to provide other information about the person with dementia.

Whilst on the ward please ask a member

It provides a ‘snapshot’ of the person with dementia, giving information about them as an individual, such as needs, preferences, likes, dislikes and interests.

FOR FURTHER ADVICE PLEASE CONTACT:

YES / NOCONFUSION ASSESSMENT METHOD

MANAGEMENT OF CONFUSION

• Treat underlying cause• Appropriate lighting levels• Consider single room/small bay/close to nursing station• Provide repeated visible and verbal clues to orientation for example clocks/calendars• Provide reassurance/explanation in short sentences• Ensure continuity of care for example one nurse to establish a rapport• Ensure glasses/hearing aids are worn and working• Avoid inter and intra ward moves• Avoid catheters• Encourage early mobilisation• Ensure adequate pain control-regular pain relief is preferential to ‘as required’• Establish regular sleep pattern – maintain and restore pattern. Avoid ‘naps’• Ensure good diet and fluid intake• Avoid constipation• Avoid sedation• Avoid physical restraint• Eliminate unexpected noises for example pump alarms• Encourage visits from family and friends

Management of deliriumDOES YOUR PATIENT SHOW SIGNS OF:

• Disturbance of consciousness (alertness and/or sleepiness)?• Change in cognition/attention over short period of time (hours to days)?• Fluctuating course?• Increased confusion at night? THINK DELIRIUM

HIGH RISK PATIENTS

• Advanced age• Severe illness (for example in critical care)• Diagnosis of dementia• Physical frailty• Admitted with dehydration/infection• Visual impairment• Surgery• On certain drug treatments such as anticholinergics and opiates• Alcohol excess

COMMON CAUSES

• Infection• Neurological – for example stroke, epilepsy, acute brain injury• Cardiological for example heart attack• Respiratory – for example pulmonary embolism, hypoxia• Endocrine/Metabolic – for example hyperglycaemia• Drugs

The Confusion Assessment Method (CAM)

The CAM should be used as a screening tool for delirium. It is easy to use and in addition to good observation skills helps to identify whether a patient has delirium. The CAM should be used on admission and frequently throughout admission to detect improvement/deterioration in confusional state.

1. The history of acute onset and fluctuating course Obtained from family member or nurse and is shown by positive response to the following questions: Is there evidence of acute change in mental status from the patient’s baseline? Does the (abnormal) behaviour fluctuate

during the day, that is, does it tend to come and go or increase or decrease in severity?

2. Inattention This feature is shown by a positive response to the following question: Does the patient have difficulty focusing attention,

such as are they easily distracted or do they have difficulty keeping track of what is being said?

3. Disorganised thinking This feature is shown by a positive response to the following questions: Is the patient’s thinking disorganised or incoherent? Is

the conversation rambling or irrelevant, unclear with an illogical flow of ideas or unpredictable switching from one subject to another?

4. Altered level of consciousness This feature is shown by any answer other than ‘alert’ to the following question: Overall, how would you rate this patient’s level of consciousness? (alert [normal]), vigilant [hyper alert], lethargic [drowsy,

easily aroused], stupor [difficult to arouse], or coma [unarousable]) The diagnosis of delirium by CAM requires the presence of features 1 and 2 and either 3 or 4.

Emma Ouldred Dementia Nurse SpecialistExtension 3420 or Air Call KH 3420

Nicola Cook Modern Matron NeurosciencesExtension 8820 or Air Call KH 4445

Dr Dan Wilson,Consultant Geriatrician Air Call KH 3166

June 2008

FOR FURTHER ADVICE PLEASE CONTACT:

Alison Haynes Kathy Golisti Dr DasLead Nurse Dementia Dementia Support Nurse Consultant Stroke PhysicianExtension 4738 or bleep 265 Extension 4738 Bleep 265 Extension 2374 or Air bleep switch

Thanks and acknowledgement to King’s College Hospital

Audit of the use of anti-psychotics in Burton Hospitals NHS Foundation Trust

Prior to initiation of treatment

Were target symptoms identified and documented? YES NO

Were these symptoms quantified and documented? YES NO

Reason given for treatment –

Other possible causes of symptoms (e.g. pain, behaviour of others, environment, physical health, depression) considered? YES NO

Non-pharmacological approaches considered or tried prior to use of anti-psychotics? YES NO Assessment made of current cognitive state? YES NO

Initiation of treatment

Evidence of discussion having taken place with patient and/or carers of:

- potential risks and benefits? YES NO - potential risk of CVA? YES NO

- potential risk of cognitive decline? YES NO

Review and duration of treatment

Frequency of review of treatment

No review 6 weekly 3 monthly less frequent

Evidence of review of affect of treatment on target symptoms? YES NO

Evidence of assessment of cognitive state? YES NO

Duration of treatment –

Burton HospitalsNHS Foundation Trust