Fremantle Hospital

Ward adaptations for patients with cognitive impairment

Fremantle Hospital (FH) is a 300 bed public hospital in central Fremantle, southwest of Perth. It has recently undergone reconfiguration to align itself with Fiona Stanley Hospital, providing hospital care to the ever expanding elderly population. It is envisioned that FH will become the Centre of Excellence in Aged Care.

Caring for Cognitive Impairment campaign certificate

Cognitive impairment is often not diagnosed or misdiagnosed resulting in adverse outcomes for patients.

This change has provided the opportunity to make the hospital ‘dementia friendly’ by improving the environment and introducing standardised changes throughout the whole hospital in order to:

  • Increase staff confidence and job satisfaction
  • Have positive results from patient/carer surveys
  • Possibly reduce length of stay
  • Improve coding of delirium/dementia from better recognition and documentation-this impacting on hospital funding.

Method:

A Reconfiguration Team was created and expressions of interest sought from nurses who had indicated interest in the subject. Meetings were held and ideas shared and a plan formulated. The lead cognitive champion visited care facilities harnessing information on dementia friendly environments and also sought advice from the Dementia Lead at Royal Perth Hospital who visited FH and offered support. The project has been enthusiastically embraced and work has commenced on all the wards that will be accommodating patients with cognitive impairment in the reconfigured Fremantle Hospital.

Cognitive screening and delirium assessment tools already utilised at FH include MMSE, MoCA, AMT4, CAM.

Matters addressed:

  • Card access only doors installed at the entrances to the wards providing a secure environment

    Hospital bathroom with blue toilet seat

    Blue toilet seats and universal black & yellow signs and symbols

  • Fire escapes made tamper proof
  • White toilet seats replaced with blue
  • Lighting has been changed throughout the entire area reducing shadows and increasing illumination
  • Night downlights have been installed in passages and green nightlights at bedsides replaced with LED lighting
  • All doorways have been framed with coloured frames to accentuate pathways through doors
  • Implementation of the Cognitive Impairment Identifier to be discussed with the Cognitive Impairment working group at Fiona Stanley Hospital
  • Each bed and belongings cupboard to be coordinated with pictures of simple objects/animals/flowers for ease of identifying patients’ space

    Hosptal ward with green door frames

    Coloured door frames to accentuate pathways through doors

  • Current reception desk upgraded and resurfaced using appropriate colour
  • Signposting of areas to be in black & yellow using universal signs and symbols which are not language dependent
  • Orientation clocks installed
  • Coloured bed covers in process of being sourced
  • Bedside curtains have mesh surveillance panels
  • Catering department providing coloured crockery and utilising red serviettes to identifypatients requiring assistance with eating
  • Implementation of ‘Who am I?’ carer questionnaire
  • Activity boxes created

    Carers corner with orientation clocks and entertainment

  • Dementia information folder in process of creation
  • Donations from the public of games and puzzles
  • There is the intention to improve the ‘green area’ outside the canteen to provide a pleasant outside sensory space in which patients can sit or walk.

Future direction

Model of nursing:

  • Team nursing with assistants in nursing (AIN) support
  • All RNs and ENs to gain an understanding of the care necessary for patients with cognitive impairment
  • An occupational therapy assistant recruited to provide group therapy
  • A pool of AINs has been recruited to provide dementia specific care rather than the companion model previously used
  • Education to continue for all levels of Nursing staff/AINs. To be organised with Staff Development department utilising staff who have undergone training with Alzheimers WA
  • Develop a group of volunteers to assist with occupational therapy/entertainment
  • Ongoing review and assessment of needs where not already addressed.

The Fiona Stanley Fremantle Hospitals Group (FSFHG) is developing a Cognitive Impairment Reference Group.