The BMJ Awards 2020: Innovation in quality improvement

Dementia friendly ambulance

Ambulances can be disorientating and confusing for people with dementia, with lots of background noise such as beeping machines, says Charlotte Walker, ambulance operations manager with East Midlands Ambulance Service.

The ambulance trust saw more than 43 000 patients with dementia in 2018-19, with over 70% being taken to an acute hospital. Working with a patient group, UnityDem, the team looked at how they could improve the experience of travelling in an ambulance for patients with dementia.

The window in the back of the ambulance was found to be reflective at night and likely to cause confusion in those with advanced stage dementia. A window cover was designed with a neutral design featuring flowers, birds, butterflies, and foxes to encourage conversation and act as a focal point.

Tailored playlists for different age groups were introduced, which can be played to mask background noise and reduce anxiety. Another innovation was the use of twiddlemuffs—knitted tubes with ribbons and buttons—which allow patients to fiddle with a safe item, reducing the incidence of patients pulling on seatbelts or unbuckling them.

The ambulance trust is the first in the world to make ambulances dementia friendly. So far, 102 vehicles have been modified at a cost of under £50 (€57; $66) each. The impact of the project is being evaluated.

Reducing psychotropic drugs

Beechcroft is the regional child and adolescent mental health unit for young people in Northern Ireland. Young people are admitted with complex, high risk mental health conditions. Psychotropic PRN (as required) drugs are used to manage severe agitation, distress, or aggression.

The multidisciplinary …