Patients first

Reducing pre-surgery anxieties for people with dementia

A hospital in Norfolk has developed a special approach to help people with dementia feel at ease before surgery. Gareth Bracken from Living with dementia magazine reports on a way of working that puts the patient first.

Staff at James Paget University Hospital.

At James Paget University hospital in Great Yarmouth, Norfolk, many patients with dementia were having their surgery cancelled at the last minute, usually because their anxiety made it impossible to continue.

'People were fearful and would get very distressed on the ward. It wasn't safe for them to be anaesthetised,' says Sarah Hay, a specialist dementia nurse.

To combat this, Sarah and her colleague Rebecca Crossley, a learning disabilities and autism specialist, came up with anew approach for people with dementia or learning disabilities, known as the vulnerable adult pathway.

If the person is in residential care, the team will contact the home to find out more about them so that the right preparations can be made.

A meeting may also be arranged between the patient's relatives and hospital staff, including the anaesthetist.

'We adopt a person-centred approach, putting the person in the middle and adapting the service around them,' says Rebecca, 'It's about entering into their reality.'

Simple things

Chris Ellis cares for her husband David, 67, who was diagnosed with frontotemporal dementia in 2013.

David needs to have his tooth extracted but will require a general anaesthetic as he won't open his mouth.

When he was referred for oral surgery, Sarah got in contact with Chris to discuss his needs.

To decide what would work best for David, a meeting was arranged between Sarah, the theatre manager, the anaesthetist, Chris and Chris's son.

'You do worry about what may happen, because David could get distressed, but the pathway is good because now they know what to expect. Forewarned is forearmed,' says Chris.

'Simple things make life so much easier,' says Chris.

Even seemingly small adjustments can make a big difference.

'I have to dress David, which is hard, but when I explained that to them, they said we can manage without a gown,' says Chris.

'That cuts out a whole bit that people wouldn't have thought about - simple things make life so much easier.'

'As a carer, even getting someone to hospital can be difficult. But we don't have to take him for a pre-operative assessment because the staff now know about his general health,'

Chris now feels much more reassured. 'We know we're not going to have any problems,' she says.

No rules

Having developed close links with the person's relatives, Sarah and her colleague Kim Crosswell, the Patient Pathway Co-ordinator, pass information to Senior Sister Bev Gray.

Bev's team make sure that a patient's needs are met on the ward and in theatre, even if it means breaking away from what is considered normal for a hospital environment.

'We can achieve anything and everything, as long as it's safe,' says Rebecca.

Patients have gone into theatre wearing boots or make-up, even taking in their phones.

'There are no rules,' says Bev.

Rebecca adds, 'We can achieve anything and everything, as long as it's safe.'

The hospital has taken the unusual step of allowing family into the anaesthetic and recovery rooms.

'The last thing they see before they go to sleep and the first thing they see when they wake up is a loved one, if they need or want it,' says Rebecca.

Bev describes this approach as a 'no-brainer'.

'The relatives know their family member's needs better than we do, so why would we stop that?'

Importantly, staff know they have the backing to implement these different ways of working.

'We are protected in what we do,' says Bev. 'Rebecca gave me permission to do it and I know I won't be criticised.'

James Paget University Hospital staff.

A great feeling

Since introducing the pathway, the team have seen a reduction in surgery cancellations.

'We've stepped off the path of normal practice, but we've successfully treated a patient and got them home safely. It's a great feeling,' says Bev.

The team consider this approach to be part of a wider cultural change at the hospital.

'It's getting staff to see the person behind the behaviour, and realising that we just aren't understanding the person at that particular time,' says Sarah.

The vulnerable adult pathway is only one aspect of the hospital's commitment to people with dementia. They also boast a growing team of volunteer befrienders, hold music and movement sessions, and even offer pet and baby doll therapy.

They have also joined the Great Yarmouth Dementia Action Alliance, a group of local organisations working to increase awareness of dementia and make the area more dementia friendly.

'I'm really proud of what we do,' says Ali Thayne, who leads the dementia team. 'Our reputation is growing and we're getting our services out there and known, so we can support local communities before they reach crisis point.'

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