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Table 3 The finalised standards agreed at the consensus conference with allocated scores following the Delphi process

From: Developing a model of best practice for teams managing crisis in people with dementia: a consensus approach

Standard Delphi Round 1 Delphi Round 2 Final allocated score
The Crisis Service
 The service provides a timely and intensive level of support, working with people with dementia and carers/families to reduce risk, including inappropriate hospital admission. 3.4 3.8 4
 The service communicates a clear, flexible definition of crisis and its own aims to other services, people with dementia and their carers/families. 2.0 2.2 2
 The service has a definition of when a crisis is resolved to a point where intensive support from the service is no longer required. 1.7 1.5 2
 Service operational policies outlining the purpose and eligibility criteria are accessible by service staff. 1.3 1.1 1
 The service is person-centred and care is planned to meet the needs of the person with dementia and their carers/families. Service staff are caring, approachable and professional, and treat people with empathy and understanding. 3.3 3.5 4
 Service staff work to build a rapport with the person with dementia and their carers/families to ensure they are involved in decision making. 2.3 2.3 2
 All service staff feel confident to contribute to decision making in an open and supported process. 1.5 1.3 1
 Service staff explain the care to be delivered to the person with dementia and their carers/families at the start and throughout their involvement. Information is timely, accurate and relevant to the needs and wishes of the person with dementia and their carers/families. 2.5 2.4 2
 People with dementia and their carers/families have the opportunity to speak with service staff separately and together; they are not rushed during face-to-face contact. 2 1.9 2
 Staff are aware of cultural and minority group issues that may affect people with dementia and their carers/families, and know how to enhance their approach to support them. 2 1.9 2
 People with dementia and their carers/families have a named worker to support consistency of staff working with them. 2 2.1 2
 The service has a system for prioritising risk and assessing required levels of support for people with dementia. 2.8 2.9 3
 Each service has a senior qualified ‘duty worker’ (shift coordinator) who allocates work each day and who oversees all calls about patients. 2 1.7 2
 Service staff are able to make day-to-day decisions autonomously, in keeping with their levels of experience and in line with their professional competencies where relevant. 1.9 1.9 2
 Service staff have the means to communicate effectively using established documentation that is organised to avoid duplication and is up to date. 1.7 1.5 1
 A daily handover takes place to communicate information about people with dementia between service staff. 2.1 1.8 2
 The service uses a centralised diary system led by the shift coordinator to know where service staff are and availability for new referrals. 1.5 1.3 1
 Case load, mix and flow are measured and used to assist the organisation and planning of the service, with the staff working rota allowing for flexibility regarding staff absence and working patterns. 1.6 1.3 1
 Service satisfaction information is collected from people with dementia and their carers/families using an appropriate measure. The whole service is aware of how it is evaluated in terms of satisfaction and performance, and how these results are acted upon. The service has a process to manage all feedback. 1.7 1.5 1
 Service staff are informed of and involved with quality improvement initiatives, affording the flexibility to think creatively. 1.4 1.3 1
 All service staff have regular clinical supervision that is separate from managerial supervision and is in accordance with professional and NHS Trust standards. 2.3 2.3 2
 All service staff have regular opportunities for continuing professional development to support clinical and non-clinical skills related to the range of crises that affect older people with dementia. 1.9 1.7 2
 The service operates outside normal working hours and signposts to other community-based support when the service is closed outside of these hours. 2.6 2.7 3
 The service communicates its referral process to people with dementia, their carers/families, and other relevant organisations. 1.5 1.7 2
Rapid Assessment and Intervention
 Following referral, the service makes initial contact on the same day and the person with dementia is seen within the next working day for appropriate crisis referrals. 2.6 2.7 3
 At a minimum, the service is accessible by telephone and if an answerphone or voicemail system is used, calls are returned and responded to according to risk. 1.9 2.0 2
 Service staff can see the person with dementia at their usual place of residence. 2.2 2.2 2
 Service staff use a comprehensive assessment that includes standardised measures where appropriate, risk assessments, and the views of the person with dementia and their carers/families to inform care planning. 2.8 2.8 3
 The purpose and outcomes of assessments used by service staff are clearly explained to the person with dementia and their carers/families. 2 1.9 2
 Service staff take an holistic approach, considering physical health, mental health, and social needs. 2.7 2.9 3
 Service staff provide information and education relevant to the specific dementia diagnosis, tailored to individual needs, to help carers/families support the person with dementia at home. 2.3 2.1 2
 Service staff provide interventions to improve quality of life for the person with dementia and their carers/families by providing practical assistance and problem solving techniques. 2.4 2.5 3
 Service staff review medication and monitor its effectiveness. Service staff have access to prescription of medication and are able to dispense it. 2.4 2.0 2
 Service staff engage in interventions to prevent further crisis; these may include assessment, advice and support for other professionals. 2.3 2.4 2
 Service staff signpost and facilitate referrals to other services including respite care. 1.7 1.4 1
 People with dementia and their carers/families are involved in the decision to discharge, are adequately prepared for discharge, and are aware how to re-access the service if necessary. Verbal and written information is offered which includes information about onward services organised by the crisis service. 2.2 2.5 3
 The service takes a multidisciplinary approach and has awareness of, and immediate access to, other relevant professional disciplines. 2.4 2.6 2
 The clinical lead for the service has specialist knowledge and skills relevant to working with older people and with dementia. 2.5 2.3 2
 Service staff have specialist dementia knowledge and skills through training and/or appropriate clinical experience. 2.5 2.7 3
 The service has administrative support that is sufficient to meet current demand. 1.6 1.6 1
 The service has an operational plan which includes staff mix and bandings, and roles and responsibilities. 1.4 1.2 1
 Service staff understand all relevant legislation. 1.9 1.7 2
 The service is embedded within established pathways of care and policies exist for working with all other relevant agencies, to include social care, emergency services, charities, and the voluntary sector. Other agencies and services have an accurate perception of the crisis service and its remit. 2.4 2.6 3
 Agreements are in place to support cross-boundary working across geographical and commissioning areas, for example, with neighbouring health services and local authorities. 1.6 1.4 1
 The service liaises with the person with dementia’s General Practitioner (GP). The service is explicit with GPs about what timely information is required in a referral, and what physical health checks should be undertaken prior to referral. The service includes GPs in decision making where relevant and through correspondence. 2.4 2.1 2
 The service has good communication with other services involved in the care of the person with dementia and their carers/families to avoid unnecessary duplication of assessments. 1.8 1.6 2
 Joint visits between service staff and professionals from other agencies take place when necessary. 1.4 1.2 1
 Service staff and professionals from other services attend each other’s meetings when necessary, and appropriate escalation procedures are established and shared when required for complex cases. 1.1 1.0 1
Service Resources
 The service has access to appropriate space to facilitate Multi-disciplinary Team (MDT) meetings, and for staff to complete paperwork and conduct telephone calls of a confidential and/or sensitive nature. 2 1.9 2
 There is provision of Information Technology (IT) resources and associated IT support appropriate to the needs of the service. This includes access to computer systems, including electronic notes, to enable working remotely from various locations. 1.8 1.7 2