Case study 3: King’s College Hospital NHS Foundation Trust (Older Persons Ward / Environment)

Background

case3_1Marjory Warren Ward is a 30-bed ward on the Health and Ageing Unit. The ward treats and cares for older people, many of whom will have dementia, delirium or a combination of the two conditions. The ward was not originally designed to specifically accommodate the needs of patients with dementia.

Hospital admission can be a distressing and overwhelming experience for patients with dementia. Environmental factors can trigger behavioural changes in this patient group, whereby patients often wander due to under-stimulation or because signage is inadequate and they are looking for something. It is recognised that a lack of stimulation and boredom can cause agitation.

With generous funding provided by The King’s Fund ‘Enhancing the Healing Environment’ (Environments of Care for People with Dementia) programme, together with donations from the Friends of King’s College Hospital and the trust itself, Marjory Warren Ward was transformed into a dementia-friendly environment in 2012. The main aim of the project was to improve the general ward environment for people with dementia by enhancing the décor to ensure it complies with current best design practices. The project team identified four main areas for improvement:

    • Entrance to the ward
    • Day room
    • Nurses’ station
    • General orientation and clinical ‘feel’ to ward

case3_3What was done

The entrance was transformed to make it more welcoming for visitors to the ward:

The ward corridors were transformed into pleasant walkways by the use of appropriate artwork, colour and provision of lighting and interactive tactile surfaces. The ‘clinical feel’ of the ward was dramatically reduced. Hand-rails and non-slip flooring were installed throughout to promote independence and safety when mobilising. Patterned, shiny floors which might confuse people with dementia were replaced throughout. Lighting and signage were improved and day and night clocks were put up to help aid orientation.

The overall ward environment was ‘de-cluttered’ through innovative use of storage. Seating and artwork were installed around the nurses’ station to encourage patient interaction.

Seating was installed outside the ward entrance to provide a ‘quiet haven’ for patients, staff and visitors and enable them to admire the views of London from the windows there.

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The existing dayroom was transformed into a multi-sensory space. The room needed to be flexible enough to be used both for agitated patients who might require a low stimulus environment and as a space where structured and unstructured activity could also take place. Lighting, imagery and sounds can also be adjusted to suit mood in addition to the provision of reminiscence materials and atomisers. Portable sensory equipment is also provided to stimulate activity in patients who are bed-bound or who are confined to a side room for infection control reasons.

Artwork was installed in every bay to make each area distinct. Bed numbers are clearly shown to help aid orientation.

Artwork was installed throughout the ward including a tactile quilt created by patients, staff and carers with support from the Dulwich Picture Gallery. Images of the London skyline and local landmarks are seen throughout the ward to trigger conversations and memories and provide a more homely, less threatening environment of care for people with dementia.

Conclusions

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Marjory Warren Ward is now one of the highest scoring wards in the trust’s patient satisfaction survey, which includes the environment.  Patients feel more confident when mobilising. Anecdotally, when patients are transferred to Marjory Warren Ward from the Medical Assessment Unit with one-to-one nursing, this is not required 24 hours after admission to the ward. The overall impression from patients, staff and visitors is that the environmental improvements have had a significant positive impact on patient well-being and also on staff motivation levels.

Feedback

    • Makes you forget about your problems for a while. – Patient
    • Apart from the amazing environment, smells and views, I was struck by how contented the staff looked. It’s brilliant. I want to work here. Visitor
    • The ward is very patient-centred, calm and homely.Visitor
    • The ward appears very friendly and relaxing. The flooring especially has reduced the falls. Patients can walk or mobilise without the fear of falling. Sensory Room – Very relaxing and calming environment for patients and families to sit. I am very happy to work in this environment. Much cleaner, tidier and relaxing. Junior Sister, Marjory Warren Ward
    • Not only has the new ward enhanced the environment for patients, the staff have clearly benefited. There is a renewed enthusiasm for work which is resulting in improved quality of care and improved perceptions of care from the patients. Consultant Physician, Marjory Warren Ward
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Source: Emma Ouldred – Dementia Nurse Specialist, King’s College Hospital Foundation Trust