Abstract
Introduction
Person-centred care is recognised as best practice for the care of people with delirium or dementia. In Cardiff and Vale University Health Board (CAVUHB), “Read About Me” (RAM) documents are used to support person-centred care in these patient groups. However, there are significant barriers to their routine use in clinical practice (Clark, E, Wood, F, Wood, S. Health Expect. 2022; 25: 1215- 1231). We conducted a two-cycle audit investigating the use of these documents on geriatric wards in two acute hospital sites, and trialled two interventions to increase their usage.
Methods
Both rounds evaluated patients on 9 acute geriatric wards at CAVUHB. Patients with a diagnosis of dementia or delirium were identified by ward staff and medical notes, which we also used to see if a RAM had been completed. Intervention one was the installation of noticeboards on geriatric wards encouraging RAM usage. Intervention two was the implementation of a ward admission checklist as well as engagement with CAVUHB “dementia champions” to advocate for their usage.
Results
Taking the 9 wards surveyed individually, in round one, the median usage of RAMs was 25% (range of 0% to 55%), which improved to 33% (range of 15.2% to 66.6%) after our intervention. Re-evaluation 3 months later, prior to intervention two, showed that RAM usage had regressed (median 27.2%, range 0% to 50%). We will re-evaluate after intervention two.
Conclusions
Long-term improvement in RAM usage was not achieved after installation of noticeboards. This loss of drive may be due to the wearing off of the novelty of the noticeboards, leading to prioritisation of other clinical tasks. We believe a better approach could be to combine a checklist to reduce cognitive workload with engagement of dementia champions in order to improve RAM usage and therefore improve person-centred care.
Comments
Definition of a RAM booklet and usage.
Hello,
The ethos of a Read About Me book is to provide information about someone to those interacting with them. Did your QIP only look at the specific RAM booklets or any version of the same? I ask because all patients with aphasia in the SRC usually get an equivalent booklet generated by the SLT. Were these included?
Also, how often are the booklets used by staff? Did you measure this? (ie effectiveness rather than compliance)
Good to know there are specific tools in use for people with Aphasia.
We only looked at Read About Me in this project. Part of the reason for this relates to the existence of the electronic Read About Me flag on Clinical Workstation-in Cardiff and Vale. This flag persists beyond admission and so has the potential to highlight patients with cognitive impairment or previous delirium if/when a person is subsequently re admitted.
Read About Me is also the tool advocated for use across the health board. The initial phase of this work focused on Geriatric Medicine wards operating from the premise that these wards should be best equipped to be implementing and encouraging the use of RAM documents. Further cycles will focus on other medical/surgical wards.