National Audit of Dementia – care in general hospitals

National Audit of DementiaRoyal College of PsychiatristsCentre for Quality Improvement4th Floor Standon House21 Mansell StreetLondon E1 8AATel: 020 7977 4975Fax: 020 7481 4831www.rcpsych.ac.uk

Audit structure

• Core audit - all general acute hospitals

– a hospital organisational checklist - service structures, policies, care processes and key staff that impact on service planning and provision for people with dementia

– a casenote audit - 40 patients with diagnosis/ current history of dementia, audited against standards that relate to admission, assessment, care planning/ delivery, and discharge.

Enhanced audit – up to 75 hospitals

• 2-3 wards: medical or shared care, orthopaedic or surgical, optional other

– ward organisational audit - staffing, support and governance at a ward level;

– a ward environmental audit - aspects of the ward physical environment known to impact on people with dementia;

– staff questionnaires - feedback from ward staff about training, learning and development, awareness of dementia and about support offered to patients with dementia on their ward;

– carer/patient questionnaire - carers’ experience of the support they have received from ward staff and patients’ overall perception of the quality of care on the ward;

– observation of care interactions - quality of the hour-to-hour provision of care to people with dementia.

Standards underlying the audit

• National guidance– NICE/ SCIE guideline; National Dementia

Strategy; DH guidance

• Professional guidance

• Service user organisations– Dignity on the Ward (Help the Aged); Hungry

to be Heard (Age Concern)

• Areas of patient/ carer priority

Patient and carer priorities

• Care planning and support in relation to the dementia (i.e. not just the acute condition) (holistic care) from admission to discharge

• Care of patients with acute confusion• Maintaining dignity in care• Maintenance of patient ability• Communication and collaboration: staff and

patients/ carers• Information exchange• End-of-life care• Ward environment

Themes from research - training

• Organisational checklist – training in awareness received

• Staff questionnaire– details of training e.g. involving patients and carers,

approaches to distress/challenging behaviour, referral processes, adult protection policy

– feedback on training – do staff feel that they have

adequate knowledge and understanding of the needs of people with dementia

Themes – appropriate prescription

• Casenote audit asks about prescription of antipsychotics:– whether antipsychotics are prescribed during

admission– main recorded reason

Themes - communication

• Organisational checklist – what systems are in place to ensure staff know about

a person’s dementia and how it affects them– whether there’s a system for getting relevant

information from carers

• Case note audit – is information collated and transferred at relevant

points? – Is there evidence that the patient/carer have been

given information?

Communication cont.

• Staff questionnaire– do staff feel that they have information and

support to carry out care

• Carer/patient questionnaire– do carers feel they were kept informed, about

progress and discharge?– Do people with dementia feel that staff

understood their needs?

• Observation Module

Outcomes for people with dementia

• Casenote audit– length of stay– monitoring of whether needs have changed

• cognitive assessment• weight loss

– any change in place of residence

Improving quality of care

• Local reporting will allow comparison with national level data on each of the criteria

• Hospitals and wards will be asked to produce action plans

• National reporting will make recommendations for improvement and focus on identified good practice

• Participants will be encouraged to share good practice/ improvements through workshop events and email discussion