Next Steps and Project promotion

As an organisation, it has been recognised that the use of RITA for all patients within the trust has had positive outcomes and experiences for patients. Our safeguarding team will continue to champion RITA utilisation to further facilitate person-centred care.  Fund raising is underway for additional devices to better facilitate trust wide patient-staff engagement. Additional enhanced supervision training to be provided for staff, focusing on providing person-centered care, utilising RITA.

Our Dementia lead took RITA to a Place Safeguarding Conference to promote its benefits, as part of the available tools to support patient care.

The RITA project team was awarded a Gold Medal as part of the NHSE&I Reconditioning the Nation Programme for contributions to preventing deconditioning and improving patient experience.

A poster has been created for an upcoming UEA Health and Social Care Partners conference, “Collaborate to Innovate: Enabling Citizen-Centred Care” in July 2023.

A journal article is being drafted for publication evaluating the impact and implementation of the RITA devices.

Special thanks to the Health Institute Q Exchange programme for enabling this project to be undertaken.

RITA & a Safeguarding Practitioner  (Feb 23- present day)

Following on from our last report it became evident that due to the busy nature of the wards, the devices would require more hands on implementation support.

A Safeguarding Practitioner was recruited (external to original project plan), as part of her role was promoting Positive Behaviour Management and has championed RITA use, Trust wide, including with patients who have post-operative delirium, on detox or have mental health diagnoses. Devices are again being utilised well.

Data collection challenges:

Collecting and analysing meaningful quantitative data proved problematic:

• The Level of Enhanced Supervision data was unreliable as it was reliant on staff manually updating data capture forms, which was complicated by the levels fluctuating during the patients stay.
• Patients being moved from ward to ward skewed our assessment of the impact of the device, once the patient moved they no longer had access to RITA.
• There were small numbers of falls for the patients who met  project scope, meaning the results were not statistically significant
• Covid impacted Length of Stay, this was compounded by a national predicament the Adult Social Care and Community Health and Care was facing, with bed shortages causing patients to spend longer in acute care.

Ultimately due to the unreliable nature of the other quantitative data, we concede to focus only on the qualitative evaluation of the introduction of RITA.

Data and Discussion

The data from the surveys, semi-structured interviews, field notes and activity logs were thematically analysed using Braun and Clarks 6 step analysis revealing four themes:

person-centred care

facilitated meaningful activities

improving staff morale

other benefits to patients (including improved nutrition and hydration)

These themes resonates with those in the literature regarding dementia and reminiscence therapy. From the qualitative feedback the positive impacts of RITA were very evident and largely linked to the presence of the RITA champions, who were actively promoting and utilising RITA devices to stimulate conversations, games and sing-a-longs. The champions described how utilising the device as a channel to open discussion and instigate conversation. The ring fenced time provided staff to have “actual conversations” with someone, actively listening, not just part of providing personal care or medication. Facilitators or champions not only guide the patients while using activities, but also support and manage the patients, should there be distressing memories. Staff utilising RITA reported uplifting their own mental wellbeing, through being able to calm patients who had been agitated and on enhanced supervision before. Evidence says that personalised reminiscence focuses on the patient with dementia as an individual and is more likely to enhance their wellbeing. With person-centred engagement and meaningful facilitation the ward took on a different feel. A visiting consultant couldn’t believe the atmosphere on the ward when the champions were there: Patients singing and clapping along to Elvis, patients saying that having the visit from the RITA champion “made their day”.

It was evident that RITA could only have a meaningful impact if it is being utilised as the initial focal point to stimulate reminiscence, which will then lead to conversations and the improved patient experience. However, this is directly linked to the staff members having the dedicated time to provide this person-centred care.

Project Update Summary:

The project implementation commenced at the end of September 2022. Four Health Care Assistants (HCA’s) were identified as RITA Champions to support the roll out of the RITA project on the wards. The plan was for the champions to be in place for the first 3 months of the roll out. Their daily role was to identifying dementia patients from the ward handover and then engage with these patients utilizing the RITA devices. Interactions with patients would be diarize for evaluation of the project. They were also encouraged to cascade train ward staff on how the devices worked.

A 24inch touch screen and a 10inch tablet loaded with the RITA (Reminiscence) software were deployed to the two identified wards. One medical and one orthopedic ward was selected based on the on the number of patients with dementia that historically were admitted to these wards.

Initial feedback from RITA Champions was that the project has been exceptionally well received. With anecdotal reports of patients singing on the ward and “a noticeable difference to the ward atmosphere”.

Qualitative data to date:

Interviews have been undertaken with various stakeholders:

Patient:

“I enjoy everything on there (RITA), wonderful. It picks me up.”

Family Member:

 “She’d (RITA Champion) been working with him in the morning…. And as soon as we got there we could see that she was there because he can speak. Yeah. She would come back on that day and say, like, what they’ve been doing throughout the day. That tells me people care… That meant a lot to us.”

RITA champion

“I find it really, really rewarding. And it’s lovely to be able to work with patients and to see that you’ve got through. There’s an impact there. It’s lovely to be able to help the patient to engage with family members that they haven’t previously”

Ward Staff

Nurse: “We had a patient that was on a DOLS. Who was always wandering and trying to escape the ward. The RITA team worked continuously with this patient and had really encouraging results the patient used to sing along to all the songs dancing and chatting to the member of staff. He recognized her every day she come into the ward.”

Ward Manager: “RITA and the Rita’s champions have been fantastic on ward…  And I never thought that Rita would have a big impact on the ward, but it made a huge difference. I have noticed a decrease in our patients falls over the months and patients are calmer, and this is helping with our patients that are on enhanced supervision. And furthermore, really helps with our dementia patients. So, thank you to everyone who was involved in starting the project.”

Evaluation observation field notes:

·        Discussion with RITA champion: She feels absorbed and even her own mental health has improved.

·        Other benefits to patients: When RITA champions are with patients, there has been several times when they have assisted the patients with personal care needs and encouraging nutrition and hydration, which otherwise would have been very challenging when patients are agitated or aggressive.

Quantitative data

The project team is in the process of capturing falls data, length of stay and levels of enhanced supervision for the patients with a diagnosis of dementia on the identified wards. This will be compared to data from before the project was introduced. At this point we do not have data to share.

The RITA devices also captures App usage so we are able to review which Apps are most popular.

Innovative uses of RITA

·        RITA used as a translator

Reported by a RC: ‘’There was a patient from a different country. And there was a language barrier. The patient was getting frustrated …the behavioural issues was down to communication and there was an app on the RITA tablet. It’s about communicating and you could set it up as a translator, so you can type in what you want to say and you can have it translated in different languages.’’

·        RITA used as a communication board

Reported by a RC: ‘’I worked with a chap who had a stroke and he had speech problems and he was on an enhanced observations because he was very agitated, very abusive.
After working with him for a little while, I came to realise pretty quickly that the reason why his behaviour is because it was a struggle to communicate and the chap was used to one of those picture boards where he had to touch the pictures to communicate and he was getting so, so frustrated with the staff because he was trying to indicate his needs, that they weren’t getting. And so we used the RITA Tablet… (using the App) he just pressed I have a pain in my shoulder, my little finger hurt… we used that so that he could communicate. His behaviour was a lot calmer and you could see that visibly, be able to relax because he’d had his needs communicated and we’d understood them.’’

Barriers and challenges

Covid has had an impact on the delivery of the project. Two of the RITA champions were considered high risk which precluded them from attending the wards when there were periodic Covid breakouts. This meant that at times wards did not receive the roll out support initially envisaged.

One of the HCA’s resigned from her post to take on another role in November, which meant we had less champion support on the wards.

The national predicament the NHS, Adult Social Care and Community Health and Care are facing, with patients unfortunately spending longer in acute care than required, is also having an impact on the project metrics. This will inevitably skew the Length of Stay data we are gathering.

The RITA Project impact may be linked to the presence of the RITA champions more that the devices themselves. This should become evident as we enter the second phase of the project as funding for the champions has now ended and it will be up to ward staff to utilise the devices.

Ward and therapists staff have received RITA training, but regularly feedback that due to staffing issues and ward pressures they are unable to dedicate prolonged periods of time to sitting with individual patients and to utilise RITA in the same fashion as the Champions. Once Phase 2 of the project has run its course (RITA on ward with no external support) and the impact has been evaluated we will explore if the hospital volunteers could be encouraged to take up a champion role.