better medicine better health the development of an observational method (person, interactions and...

Better Medicine Better Health

The development of an observational The development of an observational method (Person, Interactions method (Person, Interactions

and Environment: PIE) and Environment: PIE)

To capture the experiences of people with dementia in To capture the experiences of people with dementia in general hospital wards, for use in a national auditgeneral hospital wards, for use in a national audit

Jill HoyleJill Hoyle

Lead Nurse Lead Nurse

Practice and Professional DevelopmentPractice and Professional Development

Elderly Care DepartmentElderly Care Department

Background 97% nurses responded always/ sometimes look

after patients with dementia

47% carer’s felt hospital stay had a negative effect on general health and well being

54% carer’s felt it had a significant negative effect on the dementia itself.


National Audit Dementia

Collaboration of 5 professional and 1 voluntary body

RCPsychs RCN RCP RCGP BGS Alzheimer’s Society


Development

Literature search and review Focus group meetings Consultation with hospital staff

PIE observational tool


Person

What do we know about the patient as a person that might help us to provide the best care possible?

How can we use this information to provide a better experience for the person with dementia?

Is a recognised tool ‘This is me’ or an adaptation being filled in and used by staff


Interactions

Are there any interactions between staff and people with dementia?

How is the person affected by the interaction? Are they likely to feel emotionally supported? Are they contributing to their care? Are they being listened to? Are they given choice? Are they included in decision making? Are all members of the MDT dementia aware of

missed opportunities?


Environment What can the person see/ hear/ smell? Is it busy or quiet? Is the person able to move freely around their

environment? Are there are any environmental or

organisational factors affecting staff and patients?

Is there anything to stimulate visually or auditory senses – are people asked


Outcome Enriching – significantly promoting the

patients physical or emotional comfort and well-being.

Neutral – meeting basic standards of care, having no apparent positive or negative effect on the patient or there is nothing much going on at all.

Depriving – detrimental to the patients physical or emotional comfort or well-being


Initial Pilot 1 hospital 2 care of the elderly wards 5 staff 13 patients 24 hours consent


Next Phase

63 patients 18 wards:

10 Elderly care4 Trauma / Orthopaedic3 General Medical1 Surgical


National Rollout Min 2 staff per hospital Observer attributes Full day workshop Education and provision of tool Flexibility of observation What to do with the information gathered


Observer attributes both must be enthusiastic about the care of

patients with dementia Have personal or professional experience of

dementia Feel comfortable in undertaking observation 1 must be a senior nurse skilled in facilitating

feedback to different teams Have seniority and ownership around practice

development to drive forward implementation of action plans

Provide an educative or supportive role to junior co-observer
