National Audit of Dementia care in general hospitals

1. 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