Table 3

Potential failures and unintended consequences of visual identifiers

Potential failure/unintended consequenceQuote
Lack of standardisation of symbols undermined their value as a quick reference cue. For example, if the patient comes to one hospital, and the next of kin are being told about this identifier, and then they go […] during the night to another hospital, which has completely different ones, it can be confusing. And doctors which move hospitals, benefit from [standardisation]. Because it’s not something new to them. They know how to approach it. (Ward clerk, 011, Site 4)
Inconsistencies in application of identifiers created inequalities. The lady I saw just now … on the Medical Assessment Unit…she’ll probably end up on one of the care of the elderly wards, she’ll be on The Butterfly Scheme and that’s fine. But if she ends up on a medical ward…, they may or may not remember to use it. (Dementia lead, 01, Site 3)
By not having [an identifier], they will not receive the additional support that they might [have] received, if people had known that they had got dementia. (Wife, 11)
Lack of closely coupled information about individual needs hindered person-centred care. It feels like the label has to […] direct them to more information. (Daughter, 03)
All it does is an identifier that they have [dementia]…. And then it’s everything else, … what this person’s like, what they need, what they’re like at home, what they like to drink, how they like their tea, you know, all that sort of thing. You can’t get that from a butterfly, you can’t get that from … anything really other than knowing your patient. (Senior nurser, 02, Site 1)
If people … base assumptions about the diagnosis… without finding out about the patient… Then you could, you could be at risk of decompensating them really, because you start doing things at them and for them, rather than letting them try to do things themselves and support them. (Senior dementia nurse, 018, Survey)
You’ve got the Reach Out To Me [booklet] in the [patient] documentation, why have [staff] not read that and why have you not seen what he likes and what he doesn’t like? […] If somebody can’t see, if they haven’t got their glasses, that’s why they can’t see. (Dementia lead, 07, Site 3)
Signalling category membership could result in stigma and discrimination. I mean I just honestly can’t stand the way that people judge dementia patients, it’s just horrible, they just think there’s nothing more you can do with them, and that’s it, you just give up. (Dementia lead, 07, Site 3)
[Staff attitude was] ‘Oh well he ain’t bothered because he has got dementia’! Neglect is what I would have said. (Daughter, 012)
Effectiveness was dependent on staff training and resources. If I had to ask like what would be the factor that affects their care, I would say it would be the staffing. Like most of the time we won’t be getting any one-to-one cover, [We had a] patient who had, who just fall because of that, because of the staffing issues. (Senior nurse, 012, Site 02)
[Instead of saying] ‘Sit down, sit down, you’re high risk of falls’ […] in actual fact we’re doing a lot of work [to develop staff] understanding, [that] by engaging them in an activity, you know, that’s going to improve their experience, make them feel more engaged, happier. (Dementia lead, 001, Survey)
We’re looking at like coping strategies with staff, how to debrief regularly with each other, how to reflect on everything. (Senior nurse, 02, Site 1)