National Audit of Dementia – care in general hospitals National Audit of Dementia Royal College of...
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Transcript of National Audit of Dementia – care in general hospitals National Audit of Dementia Royal College of...
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