Dignity in Care audit tool
There was a general consensus in Warrington Adult Social Care that residential services provided people with dignity in care but there was no actual proof to back this up. Therefore a working group was formed in 2007 to look at how this could be better evidenced and included service users, staff and managers. The starting point was to use the DH guidance around Dignity in Care and also to look at comments and complaints made about residential services and whether there were any trends. From this research eight core themes were identified to be included as part of the audit:
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To ensure the effectiveness of the audit it was decided to use an evidence informed approach. The scored audit workbook is a tool that works like an NVQ where the evidence is referenced against set criteria. This approach means that any member of staff can access the evidence in one place without having to look around in different files or folders and find out what standard or level a service has achieved and what needs to be done to improve. There is also a summary function (traffic light system) which allows a brief overview of each theme and whether it is fully achieved (green), partly (amber) or not achieved (red).
However, once the evidence was collected there was then a need for a further monitoring function to ensure that all practice was continually evaluated, hence the action plan workbook. It is intended that the action plan workbook will be used to help each service attain full compliance in each area. This process is not time limited but red and amber will be addressed with more urgency, then a green level is about monitoring continuous improvement.
To further ensure the success of the tool, staff Dignity Champions were nominated to disseminate the approach to other staff and lead on the collation of evidence. There is also a service user Dignity Champion who explains the system to fellow service users and can act as an advocate on their behalf to feed the information back to staff. There are also plans in place to nominate a carer Dignity Champion to ensure that all different view points are represented in this process.
The audit is quite a lengthy process. To use this approach you have to be self critical, open and honest about the service and this requires a range of evidence collection methods including written documentation, observation, witness testimonies and service user and carer feedback. However, as you progress through the workbook you will find that certain evidence can be cross referenced as it relates to more than one area.
This approach is more easily adapted in a long term care environment in relation to service user opinions and turnover but it can be used in short term settings. In Warrington, to improve the use of the toolkit in short term settings, there are plans to ask a representative from a local older people’s organisation to be a Dignity Champion and help in the audit process.
To begin with, staff were shown the toolkit and standards and all agreed that they provided dignity in care. However when asked to formally evidence this we found there were areas for improvement which appeared in the action plan workbook.
So far there have been many examples of service improvements. For example there was no set protocol for mealtimes so this has now been introduced. One part of this is for service users to choose whether they would like the table laid for dinner (as some people were used to this being a formal occasion whereas others liked a more informal style). This method also complies with person centred planning and not assuming a ‘one size fits all’ type approach. The service user Dignity Champion also suggested using picture menus which has been well received by people with dementia.
Also it became apparent that in some instances there was a routine of toileting. Again a new protocol was introduced so that all staff understand that people have a choice and not to make assumptions about certain tasks. In essence the dignity toolkit ensures that staff tasks are led by service users' wishes and this can be evidenced.
To further embed the dignity in care ethos, all new members of staff are asked a dignity question at interview and existing staff are asked about dignity in the annual Performance Review and Development process.
The workbook is currently being adapted slightly so that it can also be used in day service settings.
There are plans to roll out the use of the audit approach to the independent sector in Warrington via the Residential and Domiciliary Care Forum.
Available downloads:
Last updated 26/02/2010 12:23:02
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