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Quality Improvement in Specialist Dementia Units. Balmore Ward, Leverndale HospitalAuthors: Christine Murphy, Service Manager and Stephen Conlon, Senior Charge Nurse
NHS Greater Glasgow and Clyde
Introduction• Scotland’s National Dementia Strategy (2017-
2020)1 identifies improvement in Specialist
Dementia Units as a priority.
• Balmore ward is a Specialist Dementia Unit at
Leverndale Hospital, Glasgow. It is one of four
demonstrator sites - part of the Specialist
Dementia Unit Improvement Programme
(SDUIP). This is supported by the Focus on
Dementia Team at Healthcare Improvement
Scotland, NHS Education for Scotland,
Alzheimer Scotland and Scottish Care.
Method• Experience Based Co-Design (EBCD)2 was used
with a six-stage approach to improvement.
• Working with carers, staff and patients,
a combination of co-design events,
semi-structured interviews and observations
were used to identify improvement priorities.
• These included person-centred activity,
communication with relatives and carers, stress
and distress, and environment.
• The Model for Improvement3 was used with
PDSA cycles to support improvements such as a
new care plan and carer pack.
• Qualitative and quantitative data were used.
Results• Reduction in Datix reporting, including violence
and aggression by 58%, falls by 54% and staff
sickness/absence by 49%.
• Reduction in enhanced observations by 49%
since February 2017.
• Increased patient safety.
• Improved activity recording and person-centred
information in care plans.
• Increased activity levels including physical
activity.
• New care planning around stress and distress.
• Increased knowledge and skills of improvement
methodology by staff.
• Carers felt more informed.
• Increased AHP input into the ward.
Conclusions• Specialist dementia care can be improved
through meaningful staff, carer and patient
engagement and the understanding of their
experiences.
• Co-production with people with dementia in
Specialist Dementia Units needs a range of
approaches. The introduction of new
techniques, such as observation, can help
capture the patient’s experience.
• Effective leadership and a team approach are
vital. All team disciplines were involved in this
work, including third sector support and carers -
and an effective steering group helped to keep
momentum.
• Building on existing improvement experience
and culture is important where possible. Some
staff on Balmore ward had already been
undertaking improvements prior to using the
EBCD approach.
• Earlier work, such as the physical separation of
a mixed ward into two male and female units,
appeared to signal a starting point to
improvement.
• Changing day-to-day clinical activity and staffing
on the ward requires a flexible approach to
improvement.
References:
1. Alzheimer Scotland, COSLA, Scottish Government. Scotland’s National Dementia Strategy 2017-2020. 2017 [cited 2018 Aug 06]; Available from: www.gov.scot/Resource/0052/00521773.pdf.
2. The point of care foundation. EBCD: Experience-based co-design toolkit. 2019 [cited 2019 Feb 02]; Available from: www.pointofcarefoundation.org.uk/resource/experience-based-co-design-ebcd-toolkit/.
3. Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco: John Wiley & Sons; 2009.
Baseline median = 23.0
Current median = 10.5
Decrease of 54% from baseline
0
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35
40
45
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6
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Jul 1
8
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Oct
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No
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Co
un
t
Balmore falls
Baseline median = 45.5
Current median = 19.0
Improvement of 58%
0
10
20
30
40
50
60
70
80
Jun
14
Au
g 1
4
Oct
14
De
c 1
4
Feb
15
Ap
r 1
5
Jun
15
Au
g 1
5
Oct
15
De
c 1
5
Feb
16
Ap
r 1
6
Jun
16
Au
g 1
6
Oct
16
De
c 1
6
Feb
17
Ap
r 1
7
Jun
17
Au
g 1
7
Oct
17
De
c 1
7
Feb
18
Ap
r 1
8
Jun
18
Au
g 1
8
Oct
18
Co
un
t
Balmore Incidents of Violence and Aggression
Baseline median = 802.0
Median 2 = 406.5
Current temporary median = 209.0
0
200
400
600
800
1000
1200
Ap
r 1
5
Jun
15
Au
g 1
5
Oct
15
De
c 1
5
Feb
16
Ap
r 1
6
Jun
16
Au
g 1
6
Oct
16
De
c 1
6
Feb
17
Ap
r 1
7
Jun
17
Au
g 1
7
Oct
17
De
c 1
7
Feb
18
Ap
r 1
8
Jun
18
Au
g 1
8
Oct
18
Co
un
t
Balmore sickness
PDSA Cycle The Balmore Team
Driver Diagram
Reduction in falls
Reduction in violence and aggression
Reduction in staff sickness and absence
