The Dementia Care Bundle: Improving the Quality and Safety of Hospital Care for Patients with Acute Physical Illness who have Co-existing Dementia

Hospital patients with acute medical conditions and co-existing dementia often experience poor outcomes in terms of safety and quality. This 2-year quality improvement programme developed a Dementia Care Bundle (DCB) for patients with moderate to severe dementia to improve patient and family experience and to increase staff skills. This consisted of four elements;

•Knowing key personalised information about the patient within 24 hours of admission
•Personalised regular communication
•Adequate nutrition and hydration geared to patient preferences and capability
•A safe and orientating environment.

Although the elements of the DCB had good face validity with staff, significant barriers were encountered to its implementation. To overcome this, a suite of underpinning interventions were developed including a dedicated dementia ward and outreach team; and a staff and volunteers skills development and education programme. These changes in the organisation of care enabled the DCB to be delivered reliably and consistently at an individual patient level. During this time, staff and families noted significant improvements and complaints fell to zero for patients on DCB. Patient outcomes including weight, mobility, falls, antipsychotic medication usage and hospital acquired urinary infections were identified as being positively impacted by DCB implementation. Pre-post point prevalence audits showed patients were more likely to return home post DCB implementation but length of stay remained unaltered. Staff attitudes, job stress, job satisfaction, staff turnover and sickness were not adversely affected by the DCB. The DCB implementation required investment in a suite of interventions to ensure consistent delivery.