Our project aimed to develop, implement and evaluate a specific section for recording dementia on the South Central Ambulance Service (SCAS) electronic patient record (ePR).

In previous work, we found that dementia was recorded in 16 different free-text fields on the ePR, making it difficult for others referring to the record to find the information. Clinicians surveyed suggested a designated ’dementia tab’.

We have developed and implemented a dementia tab on the ePR, measured its use and surveyed clinicians to gather their views and experiences regarding use and impact on patient care. We have found recording of dementia has increased overall, and the new tab is being used in the majority of cases. Staff have found it easy to use and helpful and have suggested different types of dementia could be added. We will discuss results from the audit and survey with partners within SCAS, those who work at the interface with the emergency services including health, social care, voluntary and community services, and the public. This will enable us to gauge the success of the project in improving information flow between services and identify what more can be done to improve care pathways for older people living with dementia. We would really welcome connections with Q members involved in emergency care and/or with a special interest in the pathways of care for people living with dementia, particularly those within the Ambulance Services and QI SIG – please get in touch!

As this project has several different components, it was a challenge to initiate all the different activities and keep making progress in all areas. It was important to identify all the key stakeholders who would be pivotal to the project’s success, including contracts and finance departments; software development and implementation leads; people skilled in making educational materials; reviewers for the survey protocol and survey questions/format; communications departments; supportive executive leaders; team leaders; and members of the public who were interested in the project. This ‘mapping of people involved’ was recommended to us in the Q Exchange workshops, and we can recommend its early completion!

What we have achieved so far and related learning:

1.       Agreements and financial contracts between NHS and academic institutions are in place. This took time to navigate the appropriate pathways for this type of project. Consultancy pathways were used, but note that these include VAT and need to be budgeted for accordingly.

2.       We have had media releases across the patch to local newspapers and radio stations. The team learnt from working together with the South Central Ambulance Service (SCAS) media and communications department about optimising style of writing for press releases, and how to manage radio interviews. We also identified further training needs to prepare for successful radio interviews and what to expect on the day.

3.       We have developed, tested and released the dementia button on the electronic patient record (ePR) and gained a deeper understanding of the development cycle for changes to be implemented in the ePR and the importance of having a team member with expertise in ePR / business intelligence to guide the process. The Welsh Ambulance Service dementia lead contacted the team as they are undertaking similar work, enabling further discussion and sense-checking of the project and the potential for sharing results to maximise impact / define further collaborative work.

4.       We have tested audit procedures for downloading data from the dementia button and verified that the button is being used. Data from the first few weeks following release show use of the button in approximately 70 incidents per day, with additional text provided regarding patient history / symptoms / social context in around 40 incidents per day.

5.       We have developed and released educational materials for SCAS staff – an infographic and a guided video – to supplement the routine information given to teams around ePR changes. In doing this, we’ve collaborated with the SCAS Education Technologies (EdTech) team, learning about what they can offer, their skills and what they are able to deliver.

6.       We have held two engagement meetings with members of the public, including people who volunteer for SCAS as Community First Responders (CFRs) to discuss the project and gain their feedback. We learnt that patients/the public really want to see information regarding dementia flowing through services and not to be ‘collected again’ in each step in the patient journey which again risks losing relevant information. Also, that we need to engage with the linked services (emergency departments, GPs, social care) when we are disseminating our research. We also need to consider the role of the SCAS Patient Transport Service (PTS) in safeguarding for people with dementia at discharge. CFRs have also identified additional training needs around managing patients with dementia. We may need assistance in dissemination to these wider groups from organisations such as the Wessex and Oxford Academic Health Science Networks (AHSNs).

7.       Team members have benefitted from attending the Q-Exchange workshops on methods evaluation and are currently using new knowledge and support from mentors on the workshop to develop the evaluation phase of the project. One member is also part of a Q Exchange Action Learning Set, which has been very valuable in hearing how other Q members have dealt with issues in their projects and learning a new way of thinking through issues which can be applied more widely.

What could others learn from our experience? (in addition to the above):

1.       As advised in the Q Evaluation sessions, making a logic model of the project, including inputs, outputs, and mapping who is involved with making each step work and what are the lines of communication that need to be put in place at the beginning of the project is extremely useful.

2.       We now have a better understanding of steps involved and time taken to implement changes/solutions into the electronic patient record, and that it is important to manage expectations around timelines for IT development and delivery. We have adjusted to this challenge by being flexible with the Gantt chart and bringing forward other activities where possible.

3.       A general challenge faced in project delivery are the pressures and workload NHS staff are managing, and the difficulty in finding capacity to be able to prioritise incoming one-off projects into the existing workload. Having a diverse project team with different professional roles, links and expertise has been essential to be able to progress the different aspects of the project, for example business intelligence, education, clinical, academic and public involvement and NHS research leadership.

Our next steps over the coming months:

1.       We will extract data for the re-audit in April 2023 to see how the introduction of the button has impacted on recording of dementia and if there are any changes in referrals and hospital transfers.

2.        have now finalised the content for the questionnaire for staff about the how they are using the button and the impact it is having, and aim to administer it widely across the Trust in April/May 2023.

3.       We intend to disseminate our work by presenting to public patient involvement (PPI) groups, at national conference(s), via peer-reviewed journals and via National Ambulance Research Steering Group (NARSG) from June to October 2023.

4.       We will also hold a team away-day with invited stakeholders to discuss the results of the project and see what additional quality improvement projects or research funding bids would be a priority going forward to improve care for older people within the region.

How can the community get involved in our project?

At this stage, we would be REALLY KEEN to hear from people working in health and social care services that receive handovers or reports from ambulance services as to how information on dementia from the ePR could be best communicated or what they might like to see in the free text box next to the dementia button to help them with their continuation of care. (Please get in touch!)

We would also like to hear from people in the Ambulance Services QI group about their thoughts on the project, ideas for routes of dissemination, anyone working in a trust thinking of doing something similar or also adapting their ePR to expand information on dementia and/or frailty or more person-centred care for older people.