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Summary of Outcomes and Recommendations
Background
As some of you may remember, the GTKM document was launched in 2013, in the aim sharing valuable information, and of supporting hospital staff to have a better understanding of people with dementia who are admitted to hospital. However, the value of the use GTKM document in any transition situation, has become increasingly well recognised over recent years.
Like me, you may find it hard to believe that the GTKM document is now 10 years old! But with all the changes in healthcare during that time, is it still be fit for purpose? That’s certainly a question that we as a national group of Alzheimer Scotland Dementia Consultants (ASDC’s) felt was worth exploring on the document’s 10th Anniversary.
Consultation Process
A review of the GTKM was led by ASDC group members, in consultation with key stakeholders to gain understanding of:
- How the GTKM document is currently being used?
- What are the benefits of the GTKM document?
- What are the barriers to using the GTKM document?
- What changes require to be made to the GTKM document?
The views of Dementia Champions, Dementia Specialist Improvement Leads (DSiL’s) and staff with a specialist interest in dementia care were gathered with the aid of pre-designed survey which was shared with health boards across Scotland:
- 273 staff responses to the survey were received
Focus group discussion which supported face to face and virtual consultation with Scottish Dementia Working Group (SDWG) members and National Dementia Carers Action Network (NDCAN) members was also facilitated.
- 20 people in total contributed to focus group discussions (10 people living with dementia, 7 family carers and 3 Alzheimer Scotland staff members.
Feedback was also provided from the Royal National Institute for the Blind (RNIB) information team.
Consultation Feedback
How is the GTKM document is currently being used?:
The general consensus from focus group discussions with SDWG and NDCAN members was that there should be one national GTKM document in use across Scotland to ensure continuity across healthcare areas.
185 (80%) of survey respondents reported that the GTKM document is in use within their health board areas. Of the 88 (20%) of survey respondents who reported that the GTKM document was not in use, 18 (91%) reported there was not an alternative document in use, 2 (9%) reported that there was.
There was good evidence of the documents being completed to support both the needs of people with dementia and other patients with communication difficulties. This would be in keeping with the original intention of the GTKM document, in that it can be used with anyone who may benefit from its use. However, only 36 (19%) reported that the GTKM is always used to inform care.
This would support focus group feedback which indicated that despite information being provided, the essentials are still not always used to inform care.
What are the barriers to using the GTKM?
Three key emerging themes from survey responses were identified in relation to the perceived barriers to use of the GTKM:
“Time pressures for nursing staff to familiarise themselves with the information and to use this to inform care plans”.
- 2. Absence of Family Input:
“When there are no family members to provide information and the patient is unable to do so themselves”.
“There are some cases where the information provided can be vague”.
What are the benefits of the GTKM:
Evaluation feedback from all stakeholders did indicate a general consensus of opinion that the GTKM has a positive impact in practice. Four key themes emerged from survey feedback:
Theme 1: Supporting Person-centred care
“I have seen the GTKM being used to inform many aspects of person-centred care including routines to meet preferences in relation to aspects of fundamental care”.
Theme 2: Preservation of Personhood
“Helps the healthcare provider see the person as an individual, not just another patient with an illness. Let’s patients and families know that we are actually interested in them, not just their illness”.
Theme 3: Supporting therapeutic communication and engagement
“Provides examples of interests/what matters/previous life experience to facilitate good staff-patient relationship, meaningful conversation to improve patient’s experience”.
Theme 4: Preventing and responding to stress and distress
“One specific situation was where personalised information was used to positively support a person through hallucinations using positive life events as a focus. With use of the strategy detailed in the GTKM staff were able to use consistent approaches to achieve positive outcomes for the person”.
What changes require to be made to the format/content of the document?
83 (45%) of survey respondents felt the booklet format should remain unchanged. Feedback from stakeholders also indicated that they felt the format of the booklet should remain un-changed and that the general content of the booklet remains fit for purpose, although some key suggestions in relation to potential changes/additions to the document were made:
- Space for a summary of/to highlight key information
- Signposting to guidance notes
- Additional information for inclusion in guidance notes.
- Availability of an exemplar GTKM to support completion.
Conclusions and Outcomes:
Conclusions drawn from the review are that the GTKM remains fit for purpose, although the suggested minor modifications to the content would aid completion and the gathering of key aspects of personalised information. Content of the GTKM booklet has therefore been modified to reflect key points from feedback received during the consultation process. This can be accessed via the link below and will be available for future order in hospital settings across Scotland.
https://www.alzscot.org/our-work/dementia-support/information-sheets/getting-to-know-me
However, although the GTKM remains fit for purpose and the benefits of its use are clear, concerns have been highlighted about barriers to its use and its consistent application in practice. We would therefore recommend that education about the role, use and benefits of the GTKM document should be included in relevant programmes of education within all health board areas.
Copies of the full consultation report can also be made available on request to:
Susan Holland, Alzheimer Scotland Dementia Nurse Consultant
Email: Susan.Holland@aapct.scot.nhs.uk
Contributor: Susan Holland, Alzheimer Scotland Dementia Consultant.
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