Enter and view: Ward 6 Harplands

Healthwatch Stoke on Trent conducted an enter and View on Ward 6 Harplands Hospital, an older people complex needs ward, on the 25th September 2017.

The visit was arranged to access how the Dignity and Respect Charter has been received by staff and residents and also due to evidence reported by a relative of a patient on Ward 6.

Observation by the Enter and View representatives reported that:

The hospital is not clearly sign posted, the main car park is not big enough, staff at the reception did not speak to representatives, anti-bacterial hand sanitiser was available but no obvious signs to prompt visitors to use it, the team were not asked to sign in, art sensor taps were in use but these were not suitable for people living with dementia and the ward is trying to get them changed, 'looky bags' were available for relatives of residents, fire doors had pictures of books on them which to dementia sufferers might look like a bookcase, the signs on all rooms were word only which could confuse late stage dementia sufferers, there were no books or reminiscence activities available for residents or relatives in the lounge, there were smaller lounges where people can sit, the dining room was yellow as this can stimulate appetite, the dining room was spacious for residents to move around, there was a breakout space for relaxation but this did not have any activities available, in the sensory room none of the sensory activities were switched on, a cutting and sticking activity was taking place in the activities room, crash boxes were available for residents, there is a patients kitchen, the toilet seats are a different colour so residents can be identified, small printed activity were placed around corridors but were only typed, one of the corridors has artwork of Stoke to familiarise residents with the area, there was no information about patients on bedroom doors, many rooms seemed bare, when staff were observed interacting with patients they seemed pleasant, kind and treated them with dignity and respect, green triangles were on display to show patients at risk of falls, beds can be lowered and raised as to patients needs and mats were in use for patients at risk of falls, valuables can be locked away in bedrooms, residents without a relative have an advocate allocated, all residents are allocated a social worker, the ward has 24 hours of visiting, a physiotherapist visits the ward at least once a week, carers are invited to visit outside of allocated meal times.

Recommendations by the Enter and View representatives were:

More emphasis on the provision of activities and stimulation for patients,

Improve signage generally - promote use of hand sanitiser before entering and make activity signage larger and easy to spot,

Introduce the use of a visitors book,

Consider combining words with pictures to aid comprehension on all signage,

Liaise closer with Healthwatch Stoke so we may provide relevant information regarding, for example, Dementia Alliance,

Display our Dignity and Respect posters (which will be sent in the final report)

A comprehensive response from Jane Munton-Davies, Head of Directorate, was received on the 7th of November 2017.

85% of staff have signed up to Stoke councils Blue Iris initiative and are Dementia Friends, Car parking and signage issues have been escalated, reception staff issues have been escalated to the manager, all visitors are escorted on and off the premises so there is no signing in and out book, signage around hand sanitisation is being reviewed, signage on doors is being reviewed, some areas are designated as low stimulus areas, comments about activities are being reviewed, the breakout space is not designed for activities, sensory room equipment is being reviewed, exercise points are designed with a physiotherapist, activities are displayed pictoraly on the daily chart and the weekly chart will be changed to match this, bedrooms are personalised with support from their carer,

In response to specific recommendations the following responses were made:

Greater attention to the colour scheme to provide consistency for the patient to help reduce possible

confusion:

We acknowledge the importance of colour scheme for patients with dementia and as you note in your letter have ensured that toilet seats for example are clearly defined by colour. We would however support a review of the broader décor of the ward to ensure that our environment is as dementia friendly as possible and will take this recommendation forward.

Clear explanations to be provided to visitors around the provision of activities and stimulation for the

patients:

Activities are planned in line with individual patient need and there needs to be a mix of low stimulation and more intense stimulation areas on the ward. We are mindful of meeting a range of needs and where people are experiencing distress, stimulation is not always helpful.

The team will review how activities are co-ordinated and ensure that a balance is offered that meets a range of needs.

Improve signage generally – promote use of hand sanitiser before entering and make activity signs

larger/easier to spot:

The team will review signage across the ward area. Liaison has taken place with Infection, Prevention and Control nurses to support improved use of hand sanitiser. More pictorial signs will be added to the ward.

Consider combining words with pictures to aid comprehension on all signage:

As above, signage across the ward area will be reviewed.

Embed the “This is me” profile inside the bedroom door to enable the nurse/ visitor to comprehend

more about the patient before interacting with the patient:

Staff would have detailed information about patients during handover and from the patient record. In order to maintain patient’s dignity and confidentiality the more detailed, personal information is kept in the patient bedroom in their drawer. Visitors are supported to access this if required and the “this is me” profile supports information/conversation.

Liaise closer with Healthwatch Stoke so we may provide relevant information regarding for example the

Dementia Alliance:

The Modern Matron for the ward, Josey Povey is a member of the Dementia Alliance and provides regular updates to staff. We would welcome closer links with Healthwatch Stoke and will arrange a meeting to explore opportunities.

Display dignity and respect posters (which will be sent with the final report):

We look forward to receiving the Dignity and Respect posters and will ensure that these are displayed prominently on ward areas.