This Bristol-based project will put people with dementia at the heart of hospital design to improve their experience of care, highlighting the important role the environment can play in supporting innovation in service delivery and care quality.

This project will improve the hospital environment by using a model that has worked well in other hospitals throughout the UK elsewhere; it has had lots of benefits but is also low cost. Our project will allow us to change one ward in each hospital in Bristol – the Bristol Royal Infirmary Hospital (BRI) and the new Southmead hospital.

The idea is that changes are made to a ward by the ward team, voluntary representation, hospital artist, with the help from people with dementia and their carers/families.

The types of changes that are likely to happen on the ward are:

• Identifying ward bays by blocks of colour behind beds, with the same block colour around the entry doors to that bay (different block colour for each ward bay). This means that people know where they are and start to recognize their ward bay, as it stands out in colour from the other areas.
• Improve ward signs – especially for the toilets and nurse station. This means people with dementia can easily know where things are.
• Changing how parts of the ward are used. One of the ward bays may become a social area for dining, socialization, and activities.
• Changing the lighting in social area, to increase alertness and help the mood of patients, carers/family and staff.
• Install under bed lighting that would come on when a patient gets out of bed at night to guide to bathroom, which will help prevent patients falling over.
• Changes to floor coverings, so people are less likely to fall over

Background

At least one in four people accessing acute hospital services are likely to have dementia and the number of people with dementia is expected to double over the next 30 years. There is increasing evidence that that the environment of care, particularly in acute hospitals can have significant and detrimental effects on people who have dementia affecting their carers and family. (Burns, 2011; Hunt, 2011; Waller, S 2012a, 2012b)

Many such patients lose their independence in undertaking activities of daily living when in hospital with the result that they may not be able to return home when the acute episode of care is completed, which is both devastating for them and their carers/family and has cost consequences for the care system. However relatively straightforward and inexpensive aspects of the design and fabric of the care environment can have a considerable impact on the well-being of people with dementia. (Burns, 2011; Hunt, 2011; Waller, S 2012a, 2012b)

Appropriately designed environments have the potential to reduce the incidence of agitation, challenging behavior and the prescribing of anti-psychotic medication, promote independence, improve nutrition, increase engagement in meaningful activities, encourage greater carer involvement, as well as improving staff morale, recruitment and retention all of which contribute to a reduction in overall service cost (Kings Fund, 2011). The Royal College of Psychiatrists Report of the National Audit of Dementia Care in General Hospitals (2011) suggested most hospitals have yet to implement such changes.

Learning from elsewhere

This project willreplicate the evidenced proven design principles and assessment tools of the Enhancing the Healing Environment (EHE) programme run by the King’s Fund. This will allow both participating trusts to explore functional, practical ways to improve hospital environments and the provision of meaningful activities where care is delivered, working in partnership with people with dementia and their carers/family.

Additionally, the project will complement the work that both trusts are currently undertaking around volunteers. Much success has been achieved using the South West Hospital standards for dementia and this work enables the trusts to continue to achieve against the outcomes identified.

This funding will enable them to implement evidenced models of care, to provide stimulating activities and a positive environment. The Trusts will then be able to evidence successful outcomes that will support their business case for future resources.

Anticipated outcomes

• People who stay on the ward to have a positive experience and feel safe and know where they are.
• Carers and families will feel that the person with dementia is calm and reassured that their needs are being met, not only by the staff but also by the environment that they are in.
• The ward team will feel they have had a say in how the ward looks and are proud of the area that they work in.
• The ward will look different with an environment that has good light, colour and interesting design features.
• The ward will have a sense of welcome and reassurance on arrival and to provide a tranquil and beautiful environment for people to be treated in.

Outcome metrics

• How many times people were moved from one ward to another. Moving between wards can cause additional confusion and disorientation for people
• How often patients fell over
• How many compliments/complaints that the ward staff get
• How long patients stay on the ward. If the environment helps people to know where they are and feel orientated, then they are likely to recover from their illness quicker and have a shorter length of stay in hospital.
• How many people go home and are then readmitted to hospital soon after. We hope that making sure people leave the hospital as well as possible, it will mean they are less likely to come back in, very soon after they have been discharged.

We will also carry out some detailed work using the “Making Involvement Count” resource pack. This is a way of listening to what people with dementia say, to make sure we really understand what they think and are feeling. This is carried out in small groups, with each person being supported by a “buddy” or friend who will make sure that they are able to share their views. This has been used with people in Bristol previously and has been very helpful. We think this is a much better way of getting feedback, than asking people to fill out questionnaires. This work is led by the local Alzheimer’s Society.

Progress update

North Bristol Trust are awaiting the final allocation of bed areas in and around their new hospital before they can make a start to their project