1. Better Medicine Better Health The development of an observational method (Person, Interactions and Environment: PIE) To capture the experiences of people with dementia in general hospital wards, for use in a national audit Jill Hoyle Lead Nurse Practice and Professional Development Elderly Care Department

2. 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. Better Medicine Better Health

3. National Audit Dementia  Collaboration of 5 professional and 1 voluntary body  RCPsychs  RCN  RCP  RCGP  BGS  Alzheimer’s Society Better Medicine Better Health

4. Development  Literature search and review  Focus group meetings  Consultation with hospital staff  PIE observational tool Better Medicine Better Health

5. 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 Better Medicine Better Health

6. 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? Better Medicine Better Health

7. 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 Better Medicine Better Health

8. 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 Better Medicine Better Health

9. Initial Pilot  1 hospital  2 care of the elderly wards  5 staff  13 patients  24 hours  consent Better Medicine Better Health

10. Next Phase  63 patients  18 wards:  10 Elderly care  4 Trauma / Orthopaedic  3 General Medical  1 Surgical Better Medicine Better Health

11. 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 Better Medicine Better Health

12. 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 Better Medicine Better Health