© Barbara Hodkinson 2012

Shared themes: Skills training: what to DO Eyes, smile: the simple but essential basics Establishing a rapport: interaction skills A consistent approach: working to an achievable system Identification: linked to a targeted response Supporting hydration: dementia-friendly encouragement Carer communication: creating a collaborative approach Reducing omission of medications: seeing them taken Respect: asking, but knowing if history needs to be verified Reviewing mapping and feedback: sharing success © © Barbara Hodkinson 2012

What is the Butterfly Scheme – and what is it not? It’s an opt-in scheme for people with memory impairment, allowing them to request a specific care response: so what about uptake? what about those who can’t opt in? It’s NOT an identification scheme: an identifier is not an end in itself, only a means to an end here, it’s a request for the targeted care response © © Barbara Hodkinson 2012 © ©

The care response: REACH © A simple five-point skills-based response: why only five? starting from a low base; the need for a consistent whole-team approach length of stay can be extended through well-meaning but inappropriate care from ANY team member building up from those firm foundations (role-specific package for all, in-house additional input for champions, etc) teaching in order to change behaviour – not to make the speaker look clever! © © Barbara Hodkinson 2012

The five points aim to ensure that: staff actively reconnect with the patient on every approach the patient is prepared for what is about to happen, not taken by surprise the placement of bedside essentials will be kept as consistent and accessible as possible hand hygiene and hydration will be insightfully supported history of all kinds will be verified after the patient has been asked courteously for it the patient will be offered instructions and information but will not be relied upon to retain it or carry it out © © Barbara Hodkinson 2012

Why do staff respond so well to the scheme? © Why do staff respond so well to the scheme? NHS staff want to care well but need support they should never be blamed for not knowing what they haven’t been taught a practical toolkit allows them their chance to shine less stress, greater job satisfaction sharing success: rewarding for those who achieve it and informative for those who aspire to it © Barbara Hodkinson 2012

Why are there two versions of the Butterfly symbol? an estimated 60% of people with dementia are not diagnosed hospitalisation exposes memory impairment if staff are alert to the signs: a golden opportunity to open the discussion the outline Butterfly can be an important tool in beginning the diagnostic process, as well as supporting delirium awareness and what if we overload the diagnostic / support process? © © Barbara Hodkinson 2012

The whole team approach - sharing success Discussion theme 1: The whole team approach - sharing success Supporting the sharing of success: formally and informally within each team and between all ward / departmental teams into the hospital-wide team The role of the champions in sharing success Suggestion: at team briefings, asking team members what they’ve achieved that may be of use to others – and what they’ve been able to learn from the achievements of colleagues © © Barbara Hodkinson 2012

Working with family carers by: Discussion theme 2: Working with family carers by: offering the scheme in a supportive way; encouraging the completion of a carer sheet; actively using the carer sheet; seeking information from and delivering information to the carer respecting the value of interaction with care home staff – and developing useful techniques for achieving that (phone? supplying care homes with copies of carer sheet?) Suggestion: identify who could phone care homes, establishing how to access the most appropriate staff member and how best to elicit the information requested on the carer sheet – building up relationships © © Barbara Hodkinson 2012

Useful add-ons to Butterfly Scheme membership: Discussion theme 3: Useful add-ons to Butterfly Scheme membership: open access for one carer at any time – and letting THEM decide when that might be desirable no bed move without seeking specific permission from a named member of staff Are there any others you can think of which might be useful? How can you develop a “can do” approach? Suggestion: when you come across instances where something dementia-friendly is deemed not to be possible, try considering what IS possible (eg the breast cancer op) © © Barbara Hodkinson 2012

Identifying dementia-related causes of extended length of stay Discussion theme 4: Identifying dementia-related causes of extended length of stay Examples: bowels, fall, morphine How can you encourage investigative reflection on apparent causes of extended length of stay – and how can you then work towards learning from those, to change practice? Suggestion: ask each team member to look at apparent reasons for extended LOS and analyse what part, if any, dementia care might have played; collate © © Barbara Hodkinson 2012 © ©

Additional discussion strands: Achieving patient hand hygiene Developing a dementia-friendly menu selection process in order to encourage better nutrition Supporting hydration – additional techniques What about staff members who aren’t achieving excellence – and who are perhaps of a higher grade than yourself? © © Barbara Hodkinson 2012

TO PEOPLE WITH DEMENTIA © Dementia care in hospitals is changing for the better – and it needed to change! Thank you for being part of that change – and let’s work together imaginatively in order to make the future for patients and staff as bright as it can be. THANK YOU FOR REACHING OUT TO PEOPLE WITH DEMENTIA © Barbara Hodkinson 2012

© Barbara Hodkinson 2012