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Caring for People with Dementia guideline - Implementation Guidance

Caring for People with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiotherapy) January 2015

Implementation Guidance for Service Managers

1. Purpose

1.1 This guidance has been written to assist service managers with the implementation of the recommendations contained within the clinical practice guideline; caring for people with dementia and their carers when attending for imaging or radiotherapy.  The full guideline has been approved by United Kingdom Council of the Society and College of Radiographers (SCoR) and is available within their policy and document library 1.

1.2 The recommendations represent best practice for the whole radiographic workforce caring for people with dementia and their carers at the time of publication. They have been developed systematically using the best available evidence from research and expert opinion, including service users, and subjected to peer professional, lay and external review. 

1.3 The SCoR acknowledges that radiographers and other health workers are accountable for the quality of their practice and some of the recommendations relate specifically to individuals and their personal, professional development. However, the context and culture of the organisation within which radiographers work directly influences their capacity to practice well. Therefore some recommendations in the practice guideline concern the organisation’s culture, systems and processes, both at department level and within the whole organisation.

1.4 This document is intended to be helpful and supportive to managers in the role of middle leaders in large organisations with many competing priorities. It is acknowledged that implementation will take time and be the subject of negotiation and compromise.  Nevertheless, the recommendations represent best practice and should become embedded over time.

2. Creating a Dementia Action Plan

2.1 This document should be developed to guide the implementation of the practice guideline. This has seven themes and it is recommended that managers structure the action plan according to these. The creation of the action plan will enable managers to identify the resources; human, financial and other, that will be needed and include them in business plans. 

2.2 Theme 1, The Practice Environment 

Patients with dementia have particular needs that are likely to mean that more time is needed for interventions and the clinical environment requires some adjustments.  This includes ensuring that the systems and processes in departments are fit for purpose. In addition, the culture in the department should be one that encourages and inspires staff to practise in respectful, compassionate, patient-centred ways. The appointment of a Dementia Champion is highly

recommended. This person can advocate for patients with dementia, assist with developing the action plan, lead any changes needed and cascade good practice. 

2.3 Theme 2, Building Relationships with Patients and Carers 

This group of recommendations deepens the building of relationships with patients and their carers beyond what is normally anticipated in imaging and radiotherapy. People with dementia need additional preparation prior to attending and patient reinforcement and reassurance during their visit. Greater collaboration with formal and informal caregivers is also needed to ensure that care is personalised and interventions and examinations more likely to be successful. The dementia action plan should identify how these will be met and prioritise any additional resources required.  

2.4 Theme 3, Strategies for Optimising Communication

Good communication is a fundamental aspect of good care and the recommendations in this section do not go beyond what should be good practice for all patients attending for imaging and radiotherapy. The dementia action plan should detail how communication strategies for people for dementia will be appropriately customised. 

2.5 Theme 4, Understanding Patients’ Behaviour; adopting positive ways to reduce distressed reactions

People with dementia may become distressed about attending for imaging or radiotherapy. Their condition may cause them to exhibit atypical distressed reactions. Staff need appropriate training to understand these and develop a range of strategies for mitigating them. Liaising with carers is the best way of finding out how an individual patient exhibits distress and can be helped to cope with it.  On rare occasions, restraint may be necessary but this must always be a last resort.  The dementia action plan should identify types of restraint and situations where it may safely be used.

2.6 Theme 5, Carer Involvement

Carers are often the best resource that the department has for enabling successful imaging or radiotherapy. Staff must work in partnership with carers and see them an important resource. The dementia action plan should reflect this and any associated training needs

2.7 Theme 6, Staff Skills and Attitudes

Imaging and treating people with dementia can challenge staff professionalism and this must be acknowledged in the dementia action plan together with identified staff development.

2.8 Theme 7, Training Needs

This section identifies the additional training and development needs for dementia-related care. The dementia action plan should contain a section that demonstrates what training will be offered, to whom and over what period of time.

3. Organisational and Financial Implications 

3.1 Implementing these measures will cause time spent with patients to increase, although carers and volunteers can play a big part if used appropriately. Managers will need to review this within their overall department business plans. If changes to systems and processes are identified, this could result in the need for alterations to ICT systems.

3.2 The appointment of a dementia champion will incur training costs but that person will be an invaluable resource for departments, especially through cascading training and development. 

3.3 Some additional resources such as preparing an induction pack or reviewing a system of patient identifiers could be a CPD task for an interested member of staff.

3.4 All staff are required to undertake CPD for their professional development and the training and development identified in the dementia action plan can form part of staff CPD activities.   

3.5 The main block to implementation is likely to be organisational and cultural since some recommendations require changes to established working practices. However, many departments are working through the changes needed to embed person-centred care more fully into daily practice and this guideline’s recommendations should be integral to this process. 

3.6 Guideline implementation will need regular auditing; an audit checklist has been included in the practice guideline to assist with this.

4. References

1. Caring for People with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiotherapy). The Society and College of Radiographers (SCoR), January 2015 http://www.sor.org/learning/document-library

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