Safewards in a Dementia Assessment Ward

Hi All

I recently saw Professor Len Bowers present on Safewards at my trust Clinical Risk Conference and wondered how this model would translate in to my own work environment.

I work on a 24 bed dementia assessment ward, where most clients exhibit high levels of challenging behaviour.
The ward team is keen to embrace change and anything that enhances care. To this end we would like to impliment the Safewards model.

Does anyone have any tips or suggestions, does or dont's for Safewards in this type of environment or working with this client group?

Thanks in advance

Spencer

Hi Spencer,

Some early morning thoughts for me:

Soft words - short term no change, longer term an exercise to condense and summarise the specific expertise of those who work with dementia suffers (I tried to get research money for this once, but failed), even longer term, work towards identifying specific soft words strategies for each patient dependent on their difficulties.

Positive words: No change

Reassurance: No change

Bad news: No change

Calm down box: Careful assessment of what goes in the box and who can use it, expansion of sensory items, but I think most of the current contents are usable - you are the one with the expertise here, Spencer!

Discharge messages: Either no change if there is turnover, or make it monthly messages, or seasonal messages. You may want to add a special one or format for carers to also leave messages

Mutual help meeting: needs a creative solution on your part. A meeting may not be suitable, but nurses and carers could work with each patient to find a small way in which they can help another? Heavily routinised and stereotyped activities might work here?

Know each other: Use lots of images and photography, simplify. Large format? Posters rather than a book? I know there is existing life history work in older peoples' psychiatry, but this exercise is not only about the staff learning about patients, it's about the patient learning about staff and each other.

Talk down: No change

Clear mutual expectations: May need to be negotiated on an individual basis via surveys and polling, plus involvement of carers as proxies. Again, simplicity will be key. Large scale and format, easily readable poster.

What are your thoughts, Spencer?

Len

Hi Len

Thanks for your thoughts!

Soft words - Here I think we already have the expertise on the ward, but may be good to formalise this in some way for others to follow and ensure knowledge is reflected in assessment and care planning.
"I tried to get research money for this once, but failed" - if ever you do I am sure our ward would like to be involved in such research. We work hard with challanging patients and while we pass on our findings/techniques with each transfer I am sure it would be useful to others to have an arsenal of tecniques approaches etc., to start with. It is sad that money cannot be found for such research as the cost of managing challenging behaviour to the health market must be huge and in our experience behavioural mangement techniques are often very effective at managing such behaviour, in many cases.

Calm down box: Amongst the team we have been discussing a widening of this to a calm down area. While the box will remain part of this, we have learnt that many distressed dementia sufferers can be calmed/distracted by performing domestic activities such as washing up, folding washing, laying a table, etc. Obviously cost here may be an issue, but we wish to explore this further in relation to the model the provision of an area for this.

Discharge messages: The use of carer messages came up in the early discussions of the model. Helping the relatives/carers feel comfortable about the ward and assessment process is important to service user outcomes. We will look at using one or two areas for carer and service user messages and see how this works out.

Mutual help meeting: We have attempted morning/community and various types of meetings/groups in the past with service users and have not really found a way to meaningfully engage more than two or three at any one time. We have spoken about carers meetings before and carers surgeries have not been utilised on the ward. This may be something we could look at via a survery of service users and carers, for themselves and as proxy. Ask what they feel would be useful and what would not etc and formulate a 'meeting' with this information. As you suggest perhaps carer involvement may be key to this issue. We will conisder this further and post what we try.

Know each other: I like the idea of posters and will discuss this with the team and look at format and display. This is an area I think will benefit from carer involvement and when we have the model running may be nice to work on as part of the admission process - over the first 72 hours, where possible.

Clear mutual expectations: Thanks for the suggestions here. The use of surveys may be a goood tool to start this ball rolling. Again I will feed them back to the team and let you know what we try.

Thanks again for your thoughts.

Spencer

Hi All

I am also looking to implement on my ward (dementia assessment) in somerset. Any tips Spencer? what has worked for you? Myself and the clinical lead for the ward are going to start by implementing the soft words interventions gradually over the next few weeks/months, and hope the rest of the interventions will follow.
How have other staff members found the implementation Spencer?
And Geoff if you are on here, i see in a post elsewhere (i think the implementation section) that you provided a link to some presentations on safe wards. Would you be happy for me to use these to present the safewards model to the rest of the ward?

Hi Spencer
would be interested to hear how you get on with this ... we have 3 Dementia Assessment Units in York and elements certainly lend themselves to adaption and implementation.

Hi Spencer, Gemma and Salli.
New to this forum. Just wondering how this is all going?
Thanks Julie