1. Malvern, a ward for people with dementia in an acute Trust Judy Haworth Speciality Doctor in Dementia Care North Bristol NHS Trust

2. Environment 18 beds with 5 side rooms Day room, calendar board, clock, nurse presence to ensure safety, good for intentional rounding and activities Dining room, all meals here, snack dispenser, bright light, looks onto garden, bird feeders Good lighting to reduce shadows Plain floor throughout Coded doors to protect charts, notes / treatment room/ kitchen/ teaching room

3. Environment This a closed ward with locked entrance door, garden gate, restricted opening of windows, all fire exits alarmed There is usually free access to the garden, weather permitting Doors are locked to make a safe area rather than to control people Signage is in words and pictures and colours. Dining room tables Coloured crockery routine, no clear glasses, Use coloured liquids rather than Water High quality lighting to reduce shadows

4. Nursing routines Aims to protect and encourage a daily routine People are in their own clothes They eat in a dining room Unless infection control intervention necessary they are in a communal/social environment during waking hours Walking to day room and dining room

5. Nursing routines Activities provided, music, vol to talk to people, newspaper, aromatherapy, massage, skittles. Intentional rounding Excessive fluid rounds (13) Staff better able to monitor and assist with nutrition in the dining room, snacks available More honest medication compliance, photos on drug charts

6. Medical interventions Review of all diagnoses / mood Access to liaison service if needed but in- house expertise Use of antipsychotics minimal Cholinesterase inhibitors used freely with more rapid titration Memantine Junior doctors given training in diagnosing and managing dementia

7. Improvements Bigger day room with “zones” Larger bedrooms for palliative and end of life care More activities Bright “day lights” in dining area Aromatherapy How to entrench the use of “This is Me” More rotation of staff through the ward