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Using experience-based co-design to develop high level design principles for a visual identification system for people with dementia in acute hospital ward settings

Published in:
BMJ Open

Macdonald A, Kuberska K, Stockley N, et al. Using experience-based co-design (EBCD) to develop high-level design principles for a visual identification system for people with dementia in acute hospital ward settings. BMJ Open 2023;13:e069352. doi: 10.1136/bmjopen-2022-069352

Why it matters

People with dementia and other forms of cognitive impairment can face extra challenges with their hospital care. One way of supporting them is a visual identification system designed to help healthcare staff recognise patients with a cognitive impairment and adapt their care accordingly.

There are already many types of visual identification systems being used in hospitals. They normally have two key elements – an identifier and information. In case of caring for hospitalised people with dementia, the identifier is usually an easily noticeable sign or symbol, like a coloured wristband, flower, or butterfly, which indicates to healthcare staff that there is further important information available about the patient’s care and personal needs.

We wanted to look at ways in which visual identification systems for people with dementia might be adapted and developed. We also wanted to identify principles that could help guide the development and use of both new and existing approaches to the identification of hospitalised people with dementia.

Our approach

We worked with healthcare professionals and carers of people with dementia to develop and evaluate a set of principles for visual identification systems.

Due to pandemic restrictions, we ran a series of remote workshops for carers of people with dementia and healthcare staff. The research consisted of three phases:

  • In phase one we gave participants scenarios based on findings from our prior research and encouraged them to discuss their own experiences of identifiers and seeing identifiers used in the care of their loved ones.
  • In phase two we used more future-focused scenarios, prompting participants to think about conditions in which visual identifiers for people with dementia can be used effectively in hospital settings.
  • In phase three, after analysing the data from the first two phases, we discussed a set of provisional design principles with the study participants.

What we found

Our findings showed that using an adapted co-design approach using creative scenarios worked well. The scenarios helped to identify existing problems with visual identification systems and engaged healthcare staff and carers in discussions about high-level design principles and how these might help improve systems of care for people with dementia.

Using this approach helped us to identify six principles and also to highlight day-to-day frictions. Participants said that along with the use of an identifier and key personal information, professional standards training, effective information and records management and improved means to involve carers and/or families were all key to the effective operation of visual identification systems. It was also agreed that the principles would need to be implemented as a set to work effectively.

We have made progress towards fully defining these principles. Future studies should involve patients with dementia and their carers, and get the perspectives of a wide range of healthcare staff (including ward managers, healthcare assistants, out-patients’ department staff, and porters) in order to make sure that visual identification systems truly support people with dementia in hospital – and those who care for them.

The six principles:

  • The hospital trust provides a professionally trained workforce and an appropriate culture of care.
  • The symbol is easily recognisable and well understood.
  • Key personal information is readily available and accessible.
  • Key personal information is integrated into the Electronic Patient Record (EPR).
  • Relatives and carers are involved in providing key information and monitoring care.
  • The principles need to function as a system to be successful.

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