National Audit of Dementia – care in general hospitals

1. National Audit of Dementia Royal College of Psychiatrists Centre for Quality Improvement 4th Floor Standon House 21 Mansell Street London E1 8AA Tel: 020 7977 4975 Fax: 020 7481 4831 www.rcpsych.ac.uk National Audit of Dementia – care in general hospitals

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. Themes – appropriate prescription • Casenote audit asks about prescription of antipsychotics: • whether antipsychotics are prescribed during admission • main recorded reason

8. 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?

9. 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

10. 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

11. 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