Improving Care for Patients with Dementia with Development of a Dementia Friendly Specialist Geriatric Ward: A Quality Improvement Initiative

Abstract Background The Irish National Audit of Dementia-2 (INAD-2) highlighted continued deficits in acute hospital care for people living with dementia (PLwD), particularly around delirium recognition, appropriate prescribing, and dementia-friendly environments. In response, a Specialist Geriatric Ward (SGW) implemented a Dementia/Delirium Care Bundle (DDCB) aligned with INAD-2 recommendations and National Clinical Guidelines (NCG21). Methods A quality improvement project was conducted in SGW, involving a two-phase clinical audit before and after implementation of a multidisciplinary DDCB. The intervention included staff training, use of bedside identifiers, personalized care plans, and environmental enhancements. Data were collected on 27 patients during pre- and post-implementation audits, assessing compliance with dementia care standards in communication, nutrition, elimination, safe mobility, and delirium recognition and management Results post implementation of DDCB and intervention compliance improved from 69% to 87%. Notable gains were observed in delirium recognition (53% to 89%), nutritional care (84% to 95%), food within the reach (38% to 100%) safe mobility (80% to 100%), evidence of pain assessment (0% to 100%), and documentation of personal preferences of patients 9 40% to 88%). Antipsychotic prescribing practices improved by 37 %, with documentation of rationale and alternative non-pharmacological strategies. Environmental changes, including orientation boards, meaningful activity resources, dementia signage with development of a dementia friendly SGW, supported patient-centered care. Conclusion The implementation of a DDCB supported by dementia-friendly environmental design and staff education significantly improved adherence to person-centered dementia care standards. Key enablers included active dementia Clinical Nurse Specialist (CNS), dementia candidate Advance Nurse Practitioner (cANP) support, multidisciplinary engagement, and tailored staff education. Ongoing sustainability efforts are required to address documentation gaps and ensure broader rollout. This model demonstrates the feasibility and impact of translating national dementia strategy recommendations into local practice.