New Zonal Engagement and Observations for Patients with Dementia

New Zonal Engagement and Observations for Patients with Dementia

Health professionals from Lancashire Care NHS Foundation Trust have successfully implemented a new observation system for patients with dementia in order to enhance patient experience.

Dementia patients at the Trust can now benefit from a new and improved observation system which will reduce levels of challenging behaviour, patient boredom and enable staff to provide safe patient care that is tailored to their needs. Patients who intermittently present an increased level of risk to themselves and others, were placed on continuous ‘Safe and Supportive Observations’ facilitated by one or more members of the nursing team.

Staff working on dementia wards across the Trust identified that the current system was not always effective for patients with dementia and often resulted in increased challenging behaviours and at times could not always be adapted to suit the individual patient’s needs. Staff feedback identified that morale was reduced due to the high levels of acuity and frequency the staff were facilitating safe and supportive observations.

Staff also noted that the use safe and supportive observations increased the Trust’s need for bank staff, which also brought challenges.

In order to reduce the level of risk and ensure positive clinical outcomes for patients and staff it was decided to introduce a new system known as ‘Zonal Engagement and Observations’, which aimed to ensure appropriate observation of individual patients without the need to assign particular nurse to be in close proximity to the patient for long periods of time.

Zonal observations and engagement aims to provide patients with increased activity and therapeutic engagement and to assess patient’s mental and physical health and document this in real time.

Staff worked together with patients, carers and relatives to co-design and plan exactly how the new system would look for patients. This included the paperwork that would need completing, the resources staff would need, the activities that would take place and the layout of the ward. During the pilot, the ward team held daily sessions with staff and opened feedback for relatives and other professionals to discuss how the project was progressing so that they could adapt and improve the process as per the challenges and experiences they faced along the way.

Dr Olufunso Aribisala from Lancashire Care NHS Foundation Trust said:

“We are really pleased with how successfully the new observation system has been introduced across the Dementia Wards at the Harbour and an advanced care ward in Blackburn and most importantly what this means for the patients that are receiving our care. The new system means that we have regular, experienced and skilled staff to care for patients and a process where staff are able to build positive, therapeutic relationships with patients and know them as individuals. We have received some fantastic feedback from staff and relatives

“Patients who pose as a risk to themselves or others are still receiving the same level of observation but in the least restrictive manner, resulting in less boredom and an improved experience for the patients, their carers and relatives.”

Following 12 months of the zonal observations and engagement approach we have evidence that incidents have reduced, there has been significant reduction in use and cost of additional temporary staff, quality of care and the level of patient engagement in activities has improved and staff morale and wellbeing has also increased.

For more information about dementia care and services at Lancashire Care please visit