Table 4 Equipping the workforce with the necessary skills and information to care for people with dementia: CMOcs, consensus statements and outcomes
| Â | CMOc | Consensus statements | Outcome | Operationalisation |
|---|---|---|---|---|
CMOc7 | Context: cognitive impairment may limit the ability of people with dementia to pass on information Mechanism (resource): staff use multiple sources of information including carers and direct observation Mechanism (reasoning): staff gain a better understanding of the individual Outcome: staff are able to provide appropriate, tailored care | Assessment should involve multiple sources of information including information from carers | Agreed round 1 (93–100%) | The assessment (Table 2) includes all of these components |
Assessment should include direct observation | ||||
A home hazard assessment should include a walk around the house to determine where actual falls have occurred and negotiate how these might be reduced | ||||
CMOc8 | Context: current staff knowledge of, and attitudes to, dementia are variable Mechanism (resource): increased dementia training is provided Mechanism (reasoning): staff gain skills in and understanding of rehabilitation for people with dementia Outcome: staff ability and willingness toengage with people with dementia is enhanced | Tier 2 training is required for intervention staff | Agreed round 2 (85%) | This was deemed unfeasible in the time available. A tailored training programme was developed, including items from tier 2 training. |
Training needs to include how to tailor an intervention for people with dementia. | Agreed round 1 (100%) | Training includes this | ||
Training needs to include advice on how to engage and motivate people with dementia. | Training includes this | |||
Training should include on the job role modelling | This was deemed unfeasible in the time available. Training delivered by therapists with experience in working with people with dementia, who were available remotely for advice. | |||
CMOc9 | Context: care pathways are often unclear Mechanism (resource): a centralised, collaborative pathway is developed and disseminated Mechanism (reasoning): staff are better equipped to refer to the most appropriate services Outcome: service users receive better treatment | The setting of the intervention should make use of existing pathways only when referral from the team deems it would be useful for the individual | Agreed round 1 (85.7–100%) | Assessment document includes tracking referrals that are decided by MDT |
A multidisciplinary team (MDT) meeting should be available if needed | • MDT composition agreed as physiotherapist, OT, support workers and geriatrician, with a general nurse available where the team already included this. Community psychiatric nurse (CPN), social workers, reablement workers, old age psychiatrists and podiatrists accessible by referral. • MDT meetings available at beginning and middle of intervention period. | |||
Therapists should offer service users information on assistive devices and facilitate delivery | This is flagged in the assessment document and available when needed |