# data[].attributes.headline
3. What could have been done to improve Mavis' experience? 

# data[].attributes.subject
3. What could have been done to improve Mavis' experience? 

# data[].attributes.body
The ambulance service could have taken into consideration Mavis' dementia and allowed for her neighbour to travel into hospital with her to reduce her anxiousness, as her neighbour is a familiar person to Mavis.

Throughout Mavis' care in hospital is it evident that communication was highlighted as an issue, as staff were not taking the time to speak to Mavis about what was happening, therefore they were unable to consent from Mavis and Mavis was unaware what was happening, if Mavis was aware then this would have reduced her anxiety levels and she might have not felt as frightened as she did within the situation.

Bethan Burton

# data[].attributes.body
It is clear in this scenario that Mavis was overlooked as a patient as only one member of staff took the time to reassure her that she would be OK by talking slowly to her so she could understand. By talking over Mavis the staff did not involve her with decisions or respect the fact that she was having difficulties processing the questions they did ask her. No one has explained to Mavis that she has had any pain relief or checked that it had been effective if she had received anything.
The staff do not adequately explain anything to Mavis and presume she knows what to expect from an X-ray.
The porter does not introduce himself to Mavis and this could increase her fear as she says she doesn't like the look of him. Had he taken the time to speak to Mavis this may have made her feel more comfortable.
It is clear that the staff involved are either not aware of Mavis' dementia or are poorly trained in how to communicate effectively with patients who are scared or confused.

Kayleigh Harvey

# data[].attributes.body
Throughout the interaction staff did not gain informed consent from Mavis and did not communicate at any point. Mavis was not spoken to or allowed to have any clear input into her care, meaning decisions were made for her. It appears staff caring for Mavis sssumed the best decisions instead of communicating with her.

# data[].attributes.body
Was This A Quality Experience For Mavis?

Mavis was taken out of her own comfort zone where she feels comfortable has a routine and feels safe. Mavis had to travel on her own in the ambulance, however why was her neighbour not allowed to go in the ambulance with her as a familiar face, this caused Mavis to be scared and worried. It doesn’t seem that the paramedics reassured Mavis or even communicated with her.

Lack of communication seems to be a major issue for Mavis, it is not clear if anybody explained to Mavis what was going on or who people were. People are communicating around her but nobody seems to inform her what is happening or what she needs to do.

As soon as someone communicates with Mavis and has a smile on their face and explains what Is happening, it allows Mavis to feel more comfortable and provides the reassurance she needs as Bill is not around. As the practitioner was approachable Mavis felt less scared.

Why did they not wait for Bill to be with Mavis during the X-ray. Mavis is in an unknown environment and keeps asking for Bill. If they waited for Bill to arrive this may have allowed Mavis to feel more comfortable and understand what is going on.

The lack of communication within the case study is the key issue that effected the quality of care Mavis received.

Nicky Adams & Katie Hutton.

# data[].attributes.body
3. What could have been done to improve Mavis's experience?
Even though the neighbour wasn't a relative the ambulance crew should have the knowledge to know that it is more comforting for patients with dementia to have a familiar face with them so that they aren't as scared so Mavis's neighbour should have been allowed to go into the ambulance with her until her husband turned up.

# data[].attributes.body
3. When Mavis got the the hospital the staff should have explained what was happening, introduced themselves and made her feel more comfortable in her environment, they could have reassured her that her husband had been contacted and was on his way.

# data[].attributes.headline
The change is to improve dementia care for patients when first admitted into hospital making it more dementia friendly 

# data[].attributes.subject
The change is to improve dementia care for patients when first admitted into hospital making it more dementia friendly 

# data[].attributes.body
Skills needed to implement changes in Mavis’ care:

·         Patience

·         Listening skills

·         Utilising a calm approach

·         Communication- communicating sensitively

·         Recognising the signs of distress because of confusion.

·         Promoting independence

·         Patient/carer and staff feedback

Using the PDSA cycle

Plan- Manging the change-

·         Utilising dementia suites where possible for patients who are admitted into hospital to promote a calming environment.  They have been proven beneficial within local trusts to help calm dementia patients due to having a homely setting with often familiar surroundings.

·         Who-  We would gather patient, carer and staff feedback so we know that there is a problem in dementia care and this need improving.

·         What- We would measure the incidence of distress within patients with dementia coming into the emergency setting and then compare it against when they were moved to a dementia suite and staff communicates using certain skills to see if this does calm the patient down.

·         Where- within the emergency setting

·         When- on first admission of patients.

Do- Leading the team

·         Utilising a multi-disciplinary team to work together to promote a dementia friendly environment for patients incorporating Care facilitators- Nurses, health care assistants, dementia specialised nurses and dementia support workers.

·         Documenting the effect of staff skills and if patients are calmer in the dementia suites

Barriers/overcoming these barriers

·         As more patients come in with dementia we would run out of space for putting people in dementia suites however we can overcome this barrier by setting out some assessment criteria for the stage of dementia a patient has as to which patients have priority.

·         Would we be able to offer enough support for patients with dementia due to staff shortages and lack of training within staff? We can overcome this barrier by providing training for staff already working on the wards they have an understanding and knowledge of how to deal with dementia patients.
Study-

·         when the plan is implemented we would look at the data and see what needs to be acted on

·         We will compare the predictions we had for our initial plan against the data we collect to see if any of the changes would be beneficial.
Act-

·         The changes that need to be made such as offering more training to staff in emergency settings to understand and recognise signs or patients with dementia who need extra support.

·         Incorporating the use of dementia suites more often.