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Improving patient experience, communication and care through digital technology – RITA

Utilise Reminiscence Interactive Therapy Activities for inpatients living with dementia. Aiming to improve communication and interaction, reduce agitation and stress. Ultimately reducing length of stay and improving patient experience.

Read comments 4
  • Winning idea
  • 2022

Meet the team

Also:

  • Alison Thayne - Dementia Lead
  • Joana Dias - Senior Sister
  • Helen Hall - Research & Evaluation Service
  • TBC patient representative

What is the challenge your project is going to address and how does it connect to the theme?

Barriers to communication can be linked to a wide variety of factors including: Learning difficulties, Memory impairments, Mental Health issues, Stroke, Intubation and Language barriers and can be distressing for service users and staff alike.

Our project will pilot the introduction of RITA (Reminiscence Interactive Therapy Activities) for inpatients living with dementia. Patients with dementia are at higher risk of falls and pressure ulcers. Hospital admission can trigger distress, confusion and delirium. Contributing to a decline in functioning and a reduced ability to return home to independent living. During hospitalisation patients with dementia fall more frequently than patients without dementia (12 % versus 3 %). Reduced communication could mean the patient may be less able to tell someone that they are in pain or want to move, which can impact pressure ulcers, agitation or restlessness. All of which can have a direct effect on quality and length of the patient’s stay.

What does your project aim to achieve?

Objective
To integrate and evaluate the use of RITA in an identified ward with patients who have dementia and other complex needs.

Anticipated Outcomes 

(Quantitative routine data) 

  • Improved pain control, behavioural scores, nutrition and hydration.
  • Fewer pressure sores and falls.
  • Leading to overall reduction in length of stay and delayed transfers of care.

(Qualitative data from patients, family and staff.)

  • Improved patient experience, engagement – better anticipated patient’s needs.

How will the RITA tool achieve this? 

  • Greater communication and relationship with health care staff through interaction with RITA.
  • Less time in bed during the day through group interactions with the tool. Sleep awake cycles become more regulated.
  • Less agitated and more stimulated throughout the day.
  • Increased interaction with staff and other patients

How will the project be delivered?

Intervention implementation:  
Exploration: A recent service evaluation has identified area requiring improvement. Implementation barriers and facilitators are currently being identified through stakeholder engagement and a capacity to implement assessment has been undertaken. Fidelity and outcome benchmarks are being identified.
Installation: Resources identified, organisation time planned, local governance requirements and training requirements reviewed.
Implementation: Initiate improvement cycles, monitor and manage implementation drivers, achieve fidelity and outcome benchmarks, further improve fidelity and outcomes.

Measuring Impact
Mixed methods evaluation of the intervention and cost benefit analysis will be carried out alongside the implementation to understand patient and staff experiences and acceptability of the intervention and report outcomes such as falls, length of stay and other safety reports compared with baseline data.

A risk assessment will be undertaken to document potential undesired impact of the introduction of the technology.

How is your project going to share learning?

Project outcomes and learning will be shared within the Trust via Leadership Forum, Patient Experience Committee and displayed on the Trust’s Quality Improvement page (and potentially the ICS QI page, once it is set up).
They will also be shared through the Q community, professional networks, conferences and on social media (we will explore journal publication)

How you can contribute

  • General sense check
  • What areas do we need to develop more
  • Suggested Links / networking

Plan timeline

1 Jan 2022 Pre change - Data collection
1 Feb 2022 Enhanced Supervision and Engagement Service Evaluation
18 May 2022 Engagement and Identification of Stakeholders.
14 Jun 2022 Commence training of patient facing staff
14 Jun 2022 Connect with other project teams utilising the same technology
27 Jun 2022 Commence implementation of new devices
1 Jul 2022 Service user and staff evaluation of new devices
7 Jul 2022 Monitoring progress and sharing learning
18 Jul 2022 Commence post implementation audits
9 Jan 2023 Review impact of introducing change idea
10 Jan 2023 Update and start implementing spread plan

Comments

  1. Really interesting project! The interface reminds me a bit of those touchscreens you sometimes get on long-haul flights with simple games, music channels, films etc - which of course are designed to appeal to as wide a user base as possible, keep us in our seats and not bother the staff too much! Reflecting on that - I wonder how you are going to set things up to encourage (safe) mobilisation around the ward where appropriate? It looks like you have thought about this and have a plan for it, would be interested to hear more detail!

    1. Hi Sarah,

      Thank you for your message. We are really looking forward to being able to introduce RITA onto our wards to help staff to support patients living with dementia or similar cognitive impairments. I think the principle behind the programme is as you described, a distraction from the situation. However it will also play an integral part of improving patient hospital experience and a method of improving communication with patients, which can be one of the contributing factors as to why patients become distressed; leading to enhanced supervision, increase in length of stay etc.

      The project will not distract from the day to day rehabilitation of the patient while they are in hospital, but act as an additional aid to engage and stimulate patients between periods of “prescribed” mobilisation. If patients wanted to mobilise they will still able to, in line with standard mobility assessments to ensure safety. Our Therapies team have developed an education programme, delivered by the ward based therapists, to the ward nurses, healthcare assistants and trainee nurse associates to develop and increase their knowledge and confidence in early mobilisation. Their overall aim is to increase the percentage of patients mobilised from bed in the first three days of admission to the ward. Together these project will work together in synergy.

      The delivery of our RITA project will be led by our Dementia Lead. Staff working with the patients will have a robust training programme and will be supported by our Dementia Team. We plan to capture feedback from staff, patients and family members throughout the project in order to make changes as required and gain the best outcomes.

       

  2. Hi Jacqueline, great to hear that the product has been having success elsewhere already. We really hope it will help our patients and staff and in the process improve patient experience.

    It would be really good to potentially share some learning if we are successful with our bid and have started our project.

  3. Jonathon we are great champions for RITA in Southern Trust. We are early in our journey but so impressed with the potential impact on patient safety, quality and experience. It s easy to use, portable and can be made so personal to the patient/client. My colleague Mairead McGahon is leading this QI project with the support of Cailin McKearney, QI Facilitator. I look forward to hearing more about your journey. We would be happy to collaborate with you and share the learning.

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