Audit of ‘This is me’ and

‘Forget me not’ on wards

Semi structured Interviews with volunteer

relatives

Observation of care

Undertaken over a 24 hour period

2. Strategies for Change

A triangulation of audit, interview and observation (Fig.1) were

implemented in order to gain a perspective on the range of issues

relating to the experiences of those patients living with dementia,

their relatives and carers.

Background: PHT Dementia screening

Jan–Aug 2014

46% of patients admitted to the

Orthopaedic Trauma Wards aged

75 years and over were living with

dementia

Fig 7. A summary of the

comments highlighted

from the ‘Observation of

Care’ undertaken

1. Aim To identify and develop interventions that will promote activities and

social interactions for those patients living with dementia whilst on a

trauma orthopaedic unit.

Team Members: R. Sherrington*, G. Baldwin*,P. Cheesman*, A. Gillon*, L. Heath*,J. Kynes*,C. Moore*, W.Rongavilla*

*Orthopaedic Unit, Queen Alexandra Hospital, Portsmouth

.

When I wander

don’t tell me to come and sit down.

Wander with me.

It may be because I am hungry, thirsty, need the toilet,

or maybe I just need to stretch my legs.

When I call for my mother

(even though I’m ninety!)

don’t tell me she has died.

Reassure me, cuddle me, ask me about her.

It may be that I am looking for the security

that my mother once gave me.

Background: Our inspiration taken from the poem ‘When I Wander’

When I shout out

please don’t tell me to be quiet....or walk by.

I am trying to tell you something,

but I have difficulty in telling you what.

Be patient. Try to find out.

I may be in pain.

When I become agitated or appear angry,

please don’t reach for the drugs first.

I am trying to tell you something.

It may be too hot, too bright, too noisy.

Or maybe it’s because I miss my loved ones.

Try to find out first.

When I don’t eat my dinner or drink my tea

it may be because I’ve forgotten how to.

Show me what to do, remind me.

It may be that I just need to hold my knife and fork

I may know what to do then.

When I push you away

while you’re trying to help me wash or get dressed,

maybe it’s because I have forgotten what you have said.

Keep telling me what you’re doing

over and over and over.

Maybe others will think

you’re the one that needs help!

With all my thoughts and maybes,

perhaps it will be you

who reaches my thoughts,

understands my fears,

and will make me feel safe.

Maybe it will be you who I need to thank.

If only I knew how.

Norma McNarhara

Fig 2. Development in ‘Observation in Care ‘

Continue with Observations of

care

Develop the

range of staff involved with the observation of care

Feed back responses to ward

staff

Observation of care undertaken when

activity trolley used

Reflections of those undertaking observations on their own

practice

3. Changes and Improvements

Identification of the significant findings led to the following cluster of

themes:-

• Self awareness of practice by reflecting on observations

• Coping with challenges

• Doing the right thing for the individual

• Promoting success through activity interaction

The following improvements were implemented aligned to the project aim

3a. The promotion of ‘This is me’

• A simple and practical tool developed by the Alzheimer's Society

helping to provide a ‘Snapshot’ of the person living with dementia.

• The use of the ‘This is me’ tool was initially audited at the start of the

QI project .

• Audit data in 2 week period 24/11/2014-05/12/2014 identified 8 patients

had been admitted with a formal diagnosis of dementia, all failed to

have a ‘This is me’ and only 50% had a visual identifier using a forget-

me not symbol.

Improvement

• By providing the 'This is me’ document in an upright holder located on

the patient locker side increased accessibility and allowed information

about the patient to be shared in social interaction(Fig3).

• To encourage engagement, the Ward Staff developed abbreviated post

card sized versions of ‘This is me’ of themselves which helped

engagement with the project.

2a. ‘Observations of Care’ Tool (RCN Workplace Resources for Practice Development, 2007)

The observations were undertaken in pairs on wards where at least one

person living with dementia was present. During the observations notes

were taken to build a picture of events, which took into account verbal

and non verbal communication, actions, events and people, in order to

develop a greater understanding about what was happening (Fig 2).

• The tool was selected for its effective approach and uncomplicated

design. A total of 36 observations (30 minutes) were undertaken to

ensure each hour over a 24 hour period was covered.

• A total of 24 staff from a broad range of staff groups participated in the

observations including Ward Managers, Registered Nurses, Health

Care Support Workers and Student Nurses.

• The observations were feed back to the staff involved to identify

learning and action points. This encouraged the ward staff to feel part

of the process with the Quality Improvement Team.

‘I want to

come back

again’

‘Lots of

memories

coming

back’

‘Reminds me

of songs my

mum used to

sing to me’

5. Achievements and Future Plans

Achievements:

Broaden staff engagement and awareness by promoting

the use of ‘This is me’ as highlighted from the interviews

and visual identifier using the ‘forget-me-not’ symbol.

Education Boards on each of the wards.

Staff boards with photos and their hobbies.

Activity Trolleys for each ward

Future plans:

Every month: Re audit of the utilisation of ‘This is Me’ every

Complete weekly ‘Observation of Care’ around the use of

Activity Trolley with a broad range of staff (Fig 2) with

observations of care particularly with those offered the

opportunity to participate with activities.

Complete weekly interviews those participating with

activities and relatives. Continue to listen to feedback from

friends and family and action as required

2b. Interviews

Seven in-depth semi structured interviews were conducted to

investigate values, reason and meaning held by relatives of those

patients living with dementia to gain an authentic understanding of

their interpretation and concepts. The qualitative data was analysed

using the whole of the transcribed interview and the notes made from

the observation of care.

Impact

These offered a range of activities (Fig.4) that could be adapted to

the individual. This empowered the staff with the ability to adapt

their approach to individuals with the implementation of activities to

increase stimulation and social interaction.

3b. Introduction of Ward Activity Trolley

Fig 4. Staff & patients engaged in activities

Fig 3. Illustration of the ‘This is me’ located in the holders on the

patient’s locker and the Staffs abbreviated post card sized versions.

3c. Improvement Music Activities Musical aptitude and appreciation are the two of the last remaining

abilities in the patients living with dementia (Alzheimer Society 2015).

Fig 6. Musical activities being undertaken to increase stimulation

and social interaction

3d. Impact of ‘Observation of Care’

The observers involved described the opportunity to step back and

see what happens in their area as an opportunity they had not been

afforded before. Helped develop self awareness of behaviour.

Helped to develop their observation skills and develop their skills of

giving and receiving feedback.

This lead to a direct impact on care by working with their

colleagues to share good practices and identify ways to improve

care (Fig 7.)

.

Equipment held on each of the Wards Activity Trolleys

• Reminiscence Picture to share books

• Percussion set

• Chatterbox cards

• Aquarium Gel Sensory Pad

• Colouring cards

• Shape sorting

• Square puzzle

• CD & song books

Fig 1. The Triangulation of approaches used

6. Lessons Learned:

Fig 5. Illustration of the range of activity equipment held on each trolley

Improvement

To help improve the patient experience and journey, the Quality

Improvement team developed three Activity Trolleys located on

each of the trauma orthopaedic wards.

Impact: Improved Patient Experience Reflected by comments below regarding the music activities and the

comments summarised from the observations of care (Fig 7). Such

activities appears to evokes emotions that bring memories, shift mood,

manage stress and stimulate positive interactions.

Opportunities to listen and observe are essential in order

to gain an insight of ‘the person in the patient’.

Staff thrive on constructive feed back.

Involving a broad range of staff is key for sustainability.

Impact • Empower staff with the ability to know the individual, through the

promotion of the ‘This is me’ scheme.