Some patients admitted to hospital for medical reasons need personal support to cope with being in a strange and clinical environment.
The enhanced care team at Solihull Hospital is always on hand to help these ‘special inpatients’ – mainly those with dementia or delirium whose complex needs and behaviours can put them and others at risk. Perhaps more importantly, the team adds to the patient’s quality of life during their stay.
Mumtaz Nayear was one of the first enhanced care team members, and has now been made coordinator. She’s an experienced mental health care assistant who joined the hospital in 2014 to help on a specialist dementia ward, preparing patients for a return to the community. Funding issues saw the ward close that same year, to be replaced by a new dementia and delirium outreach team.
The enhanced care team is one of two outreach projects. The other is centred on a particular ward, making sure patients are eating and drinking properly, and getting enough exercise, to prevent further physical problems and enable them to be discharged.
Meanwhile the dementia and delirium outreach team of three staff nurses and four healthcare assistants focuses on people who’ve been assessed as needing additional support due to a diagnosis of dementia or delirium. Ward teams identify patients they feel require extra support to stay safe and record what they feel the risks are.
This list is then reviewed by the enhanced care team, which can decide where help is most needed, taking into account the information provided by wards and staff availability. “It could be someone at risk of falling or with really complex behaviour,” says Mumtaz. The team does its own assessment to check that the patient really requires extra one-to-one support, and it’s not just a case of a ward being short staffed and struggling to provide general levels of patient care.
On most days five to 10 special patients will be referred for enhanced care. Some may be in hospital for several months if their discharge is delayed.
“Whatever the situation, it’s all about providing quality care, not just leaving the patient sitting doing nothing all day. You have to put yourself in their shoes. Our approach includes the way we speak to individuals – talking to someone, not about them – and finding appropriate activities we can do together.”
Mumtaz has created an ‘enhanced care toolkit’ team members can use with patients, which contains things like playing cards, pencils and colouring books, dominoes and word searches. She’s also persuaded the hospital’s bedside television supplier to let special inpatients watch for free. “Coronation Street is particularly popular,” she says. “You can have someone who’s frantic, absolutely desperate to go home, and they hear the Corrie theme music and calm down.
“Previously this level of support was mainly provided by whichever bank and agency staff could take the shift. Now we have a team of dedicated nurses and healthcare assistants who – although they’re bank rather than permanent staff – just want to do this sort of work,” explains Mumtaz. Their shift patterns vary depending on how many special patients have been admitted at one time.
Not all her healthcare assistant colleagues on the team have previous mental health experience but they’ve all completed intensive dementia and delirium training and now “really know their stuff”. And they’re encouraged to talk to a nurse if they’re worried about a patient, including medication or diet, and to share individual feedback on the person’s condition and needs.
The team’s manager incorporates all their suggestions into a care plan. “We work on the aspects of care we can actually change, which are often quite small,” says Mumtaz. “For example, previously a nurse would sit right next to a patient, because that’s what they’re trained to do when monitoring someone’s condition. But we’ve found people with dementia or delirium usually don’t like that, so we position ourselves near the door where we can still keep a close eye on them.
“That sort of thing goes into the care plan, and we work according to that, not generic guidelines,” says Mumtaz. As coordinator, she wants the whole team to get together regularly to ensure they’re delivering consistently high quality support.
Team members also provide reassurance to special patients’ families. “Seeing a loved one with delirium, deteriorating quickly and behaving differently, such as kicking and swearing, can be very traumatic,” says Mumtaz. “We either call the family or give them our contact details, so they can talk about it.”
The practical support the team provides is extremely reassuring for families too – especially the effort staff made at Christmas so patients wouldn’t miss out on celebrations while in hospital, even paying for cards and presents out of their own pockets.
And the enhanced care service has proved so successful there are plans to expand it to Heartlands and Good Hope hospitals.
Secrets of our success
- Double check what support patients really need
- Be prepared to adapt practices to suit the individual
- Find activities people enjoy and that also do them good mentally
- Share concerns and ideas about how best to help someone
- Take time to build relationships with families