The Value of PIEJane Buswell

Consultant Nurse for Older Adults

Clinical lead for dementia care

To describe elements of care experienced by people with dementia as more, or less, person-centred

To enable the ward team to reflect on their approach to working with people with dementia

To help NHS Acute Trusts to understand and implement person-centred c

Aims of PIE

How do we “Hear” the patient voice

• Direct comments to Ward Sisters/ Matrons• Patient feedback comments cards • Monthly postal survey post discharge• Quality in Care Audit tool • Complaints

How did we do it?

• A training day attended by senior clinical staff – matron/ward sisters to learn the methodology

• The same three wards identified that participated in the enhanced phase of National Audit of Dementia

• Each ward was observed for 2 two hours periods- one of which had to be over a meal time

What did we find?

• Some individual practitioners demonstrated a person centred approach and excellent communication skills

• Where interaction takes place it was kind and patient

• Boredom factor – on every ward – long periods of time where absolutely nothing happened for that individual

Depriving PIE Observations

• Person -Boredom overwhelming- asleep or staring blankly. Often looking bewildered

• Interaction –Little evidence of person centred care. No opportunity for many patients to talk with staff other than during direct care. Staff working around patient- no interaction at all (no smile, no “hello”) Confusion over meal choices

• Environment- No stimulation in ward areas. No clocks or calendars, pictures radio . Staff ringing bell to start protected mealtimes- no explanation of what that was

Neutral PIE Observations -

• Person- Sat in chair- hospital night clothes unable to talk to other patients as chairs on opposite side of bed

• Interaction - Care given politely, and kindly . Tasks carried out – no communication outside the immediate task .

• Environment - Ward are calm- no telephones ringing or bells buzzing. Patients could see out of window

Enriching PIE Observations

• Person -Individual wearing own nightdress, having personal items by locker. Awake and communicating with the patient in the next chair

• Interaction -This is Me by bedside- staff reading it prior to commencing any care activity. Housekeeping staff making eye contact and smiling with patient – asking them directly what they wanted. Staff walking through area- smiling and stopping to say hello – talking about the weather

• Environment - A radio playing music of a type known to be liked by the patient

Actions following PIE Observations

Awareness raising for housekeeping and importance of their role staff linked with privacy and Dignity agenda

Every ward area to have clocks and calendars placed where all patients can see them from the bedside. Input into new build of UH Bristol ensuring a communal area on ward

Update daily ward handover sheets to incorporate trigger questions re This is MeTiming of meal service to patients changed in some areas to ensure no delay between courses

How can PIE help with the Quality Agenda The “Quality Tool” audit is being implemented in UHB.

It will include observation of every nurses’ practice.

The standards being measured include:• Nursing assessments• Record keeping • Food and Nutrition• Privacy and Dignity• Falls

• Pressure Ulcers • Medicines Management• Pain management • Infection Control • Early warning scores

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Using PIE can enable Care and Compassion to be at the heart of everything we do