National Audit of Dementia (care in general hospitals) Developing standards for audit

1. National Audit of Dementia (care in general hospitals) Developing standards for audit Chloë Hood, CCQI

2. Audit background What is NAD? • Established 2008 to examine the quality of care delivered in hospital to people with dementia • Open to all general acute hospitals, or those providing general acute services on more than one ward that admit people over the age of 65, in England and Wales Data collection and participation • Round 1 2010 -11, Round 2 2012-13 • 88-98% participation by hospitals (99-100% participation by Trusts/Health Boards) Overall finding • Round 2 showed significant positive change but many best practice standards remained unmet

3. Standards for NAD - sources 2 stage literature review • National guidance • NICE/ SCIE guideline 42 Supporting people with dementia and their carers in health and social care; National Dementia Strategy; DH guidance – NSFs, hospital specific • Professional guidance • British Geriatrics Society Comprehensive Assessment; • Patient and carer representative organisations • Help the Aged Dignity on the Ward; Age Concern Hungry to be Heard • Areas of patient/carer priority • Emphasis on care and support from admission to discharge (dementia and acute condition); communication and collaboration between patients, carers and staff; information exchange

4. Developing audit standards and criteria Multiple sources for audit standards and criteria • Key source NICE guideline – highest level, strongly evidenced, best practice, with expert by experience input • Use of detailed criteria from guidance developed by professionals and organisations representing patients and carers, and setting specific guidance Example: assessment theme in the audit • Key source NICE CG 42 (first round of audit March 2010) • 1.1.7.2 Care managers and care coordinators should ensure that care plans are based on an assessment of the person with dementia’s life history, social and family circumstance, and preferences, as well as their physical and mental health needs and current level of functioning and abilities

5. Developing audit standards and criteria Relates to Statement 4 in QS 1 • Quality statement • People with dementia have an assessment and an ongoing personalised care plan, agreed across health and social care, that identifies a named care coordinator and addresses their individual needs. • Quality measure • Structure: Evidence of local arrangements to ensure services are tailored to an individual's needs. • Process: • a) Proportion of people with dementia whose individual needs are assessed and whose care plan states how those needs will be addressed. • Numerator – the number of people with an assessment of individual needs and a care plan addressing identified needs. • Denominator – the number of people with dementia • b) Proportion of people with a named health or social care coordinator. • Numerator – the number of people with a named health or social care coordinator. • Denominator – the number of people with dementia.

6. Developing audit standards and criteria Details for audit in hospital setting • BGS Comprehensive Assessment of the Frail Older Patient

7. Developing audit standards and criteria Details for audit in hospital setting • Alzheimer’s Society Care on a Hospital Ward/ This is Me

8. Audit standards and questions Section on assessment • Overall statement: All people with dementia receive a comprehensive assessment that includes assessment of their mental health needs • 19 separate standards derived from multiple sources • Assessed via • Organisational checklist (policies and procedures • Casenote audit (evidence of assessments)

9. Reporting – evidence of assessments Comparison shown in National Report

10. Reporting – personal information 74% of hospitals now have a system for collecting personal information (up from 30%). The collection of personal information could be improved, particularly in areas that could help prevent distress and challenging behaviour in people with dementia.

11. Considerations for future reporting Standards for audit were explicitly linked to NICE guidance • All standards and criteria were referenced to their key sources • Local reports gave key sources in each section Reporting could link in the same way • We could map the results to NICE quality statements – e.g. Where results show that people with dementia are not receiving a fully comprehensive assessment, Quality Statement 4 is not met in the hospital setting Feasibility will have an impact • E.g. QS4 specifies auditing care plans to show that they address needs identified by assessment • Round 1 of audit found this question had poor reliability – was not nationally reported