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Mavis is clearly scared and the different environment and people could increase her anxiety levels. If one particular member of staff were to sit with her until her husband arrived, then this may keep her calm as it appears she responds well to smiling, gently and kind people. If Mavis then builds up a rapport with the member of staff then she may discuss her feelings and how she feels i.e. pain etc with will help with her initial care

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Consent wasn't gained from Mavis prior to any intervention throughout her patient's journey. Ambulance crews could have asked if she would want her neighbour escort her in the absence of Bill pending the time he arrives as she's got dementia,which would have made her less scared and journey experience better as a result of the familiar face present.
PRN analgesia should have been given to her by the ambulance crew in order to ensure she's not in pain during the course of the journey to the local hospital.
She could have been dressed in appropriate clothing and covered with blankets with the heating switched on to ensure she's warm before embarking on the journey.
Arrangement to ensure the cat safety should be put in place and Mavis informed about this to alleviate her worries about the cat.
The hospital failed to give her a tailored individualized personalised care considering she's got dementia,erstwhile a quiet area and staff to stay with her would have been helpful.
No introduction was done or made between staff and Mavis.
Appropriate questions were not asked to ascertain her needs and establish her concerns to give her opportunity to ask questions even though she did tried and was ignored as she asks for Bill her husband.
Lack of professionalism/attitude from staff
1.Leaning and speaking over her
2.Poor admission coordination/clerking systems everyone asking same questions repeatedly.
3.No consent prior touching her
4.No assessment and understanding of the pain she's in hence lack of duty of care
5.Risk of organisational culture misleading others to agree and believe she's violence and accused of hitting them when been touched,when in actual fact she's in pain and no analgesia given.
No explanation or information regarding the care/intervention given in her own level of understanding or simple and plain words and regarding her condition-dementia.
Poor communication skills from staff as ni evidence of analgesia given at any point even though the kind nurse said she's had pain relief.
Poor patient care with the porter whistling as she transports her to and fro x-ray area. Again no consent.
She's was not involved in her care as no explanation in simple term what the x-ray is,why, and what to expect.
Basically lack of compassion as no attempt to alleviate her fears because nobody really communicated with her.

No. Not a quality experience for Mavis

Yes. Analgesia introduction consent familiar face might have helped.

No. She did not have a voice in this scenario

Been a patient advocate to Mavis
Improve how patients are dealt with professionally to make them feel safe valued involved even in their vulnerable moments.
Introduce oneself to Mavis
Explain what you intend to do and why in a way she will understand
Give her time to process the information given to her
Ask for her feedback/questions
Gain consents prior to interventions
Ensure she's pain free and comfortable
Only touch when it's necessary to do so and be calm.

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The main issues I found in this situation are; the isolation in which Mavis was left, lack of organisation straight after her admission, lack of plan regarding her care and lack of communication in her regards.

It was not a quality experience for Mavis, as the hospital lacked organisation.

A lot could have been done to help Mavis, for example the paramedics could have asked Bill’s phone number to her neighbour in order to chase him up. Moreover, a 1:1 person could have been allocated to Mavis to support her once in hospital.

Mavis did not have a voice. In this regard, I would have tried to contact her next of kin or ask to chase them up, whilst allocating a 1:1 support once realising Mavis’ condition.

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Staff did not communicate with Mavis, people talking within her hearing range about her but not too her which is unsettling and rude. The porter who was whistling but stopped to talk to others did not make an effort to talk to Mavis. A woman told Mavis she was going for an X-ray with out explaining what that was. People assumed that due to Mavis having a diagnosis of dementia, she was unable to consent, converse or understand which is not true, it appears staff did not acknowledge Mavis as a person and failed to give person-centred care.
The experience could have been improved by staff undertaking dementia training, learning basic compassion and communication skills. Mavis' husband could put a 'This is me' or similar document in place for when Mavis has to attend A&E as this can help staff understand how to reassure Mavis, if written well and the staff take the time to read the document.

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What are the main issues you find from this situation? Mavis feels very unsafe. It is not clear whether Bill is on his way or not. Many of the HCP’s are not very understanding of Mavis’s lack of understanding, there are a lot of people talking to each other and not to Mavis. Mavis is in a lot of pain, her pain relief is not enough, but it is clear she wouldn't know how to ask for more pain relief. She also is not being told what is happening in relation to her care.

Was this a quality experience for Mavis? No, other than the one friendly person, Mavis is not feeling safe and well looked after in this environment. All patients should feel safe whilst being cared for (NMC. 2015). It is clear in the scenario that Mavis is very confused, and doesn't feel orientated to her environment, orientating people who have dementia to the hospital setting can be very challenging but it is very important.

Could anything be done to improve this for Mavis? Staff talking to Mavis more, and explaining the situation and the care she will receive. There are a lot of dementia friendly tools that can be used, in Derby Hospital FT there are dementia key workers, if an area was struggling it could be requested for one of these workers help this patient in this area. Family and friends of patients with dementia offer an important asset in helping these patients understand their care and feel comfortable. Phoning her husband Bill and checking that he was coming in is very important and would help mavis feel comfortable.

Did Mavis have a voice here? Mavis is clearly struggling to vocalise the way she is feeling, probably due to fear. It is hard for patients with dementia to say how they are feeling. As Mavis doesn't feel orientated to the ward or hospital environment it can be very daunting and scary being in an place you don't know.

If no, what could you do to give Mavis a voice? This is why it is important that patients who show signs of dementia have an advocate, somebody who develops a relationship with this person to stick up for them and represent them. It can be hard during busy times for this to happen effectively. Furthermore, calling her next of kin and checking that her husband Bill is on his way. Mavis would get comfort in this.

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Stake Holder analysis: Getting all stakeholders and parts of the organisation to review the journey of a patient who has fractured a hip and re waiting an operation, and look at improvements that can be made, further focus should be on the patients who have dementia and their journey through the hospital. The Stakeholder analysis could be organised by anybody within the organisation who notices that improvements need to be made.

Try to identify where things were positive and where things may require alteration: Mavis clearly doesn't understand what is going on, it is important that she has clear communication with her HCP’s. A positive of the situation is that Mavis responded very well to the ‘nice nurse’, this shows the significant effect of basic changes in care of patients who are confused and disorientated in the hospital environment.

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·         Changes in Mavis’s care: A pathway for dementia patients to get one phone call to a next of kin before arrival at hospital.

·         Managing the change: Use a PDSA cycle to identify teething problems or as an alternative use the change response cycle assess the outcome of the pathway and map the transition and develop a modified plan of action

·         Potential barriers: 1. Time available to paramedics to get information and make the phone call.

2. Work phone for paramedics, do they exist? If not how could they be provided?

·         How to overcome barriers: 1. work with EMAS and the hospital to develop the dementia pathway to include time for paramedics to make these phone calls as long as the patient is stable and able to speak on the phone.

·                                                      2. Seek sources of funding to provide paramedics with work phone to be able to make work related call to relatives. Speak to business  telecoms providers to see if a contract could be draw up if it does not already exist.

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In order to implement any changes you have identified in Mavis’ care what skills will you need to?

Identify the change. The change is improving the patients journey when they show signs of dementia and are awaiting surgery.

Managing the change (inclusive of applicable theories) The process mapping diagram will be useful for reviewing the patients journey, and allowing different HCP’s to discuss how they feel the journey could be improved. Maybe have a fast track surgery for these patients.

Leading the team (inclusive of applicable theories): A change initiator would need to be

What barriers will come up against? Funding.

How could you prevent or overcome these barriers? Would need to argue the cost of 1:1 HCA’s looking after these confused patients.