[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 6, January 2012].
The first full report of the National Audit of Dementia across 210 hospitals in England and Wales, by the Royal College of Psychiatrists, identified the continuing need for significant improvements to hospital wards, staff awareness and training and to the general approach to care of patients with dementia. Most wards met basic safety requirements, but simple measures to reduce distress caused by unfamiliar and confusing hospital environments were commonly overlooked.
Initial Pilot Study in 2009
Royal Wolverhampton Hospitals Trust (RWHT) was one of the hospitals to participate in the pilot phase in 2009. Individual contributors included:
- Sandra Rider (New Cross Hospital).
- Jim Fan (New Cross Hospital).
- Dr Daryl Leung (New Cross Hospital).
First & Second Rounds
The second round of audit will take place in Spring 2012, and aims to include all hospitals providing general acute services in England and Wales.
The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement in partnership with other organisations. The main audit looked at 210 hospitals in England and Wales. Ward level data came from a sample of 145 wards across 55 hospitals. It included staff questionnaires and observations of care on wards.
Collaborators in this project included five professional bodies and the main voluntary sector provider of supports and services: the Royal College of Psychiatrists; the British Geriatrics Society; the Royal College of Nursing; the Royal College of Physicians; the Royal College of General Practitioners; and the Alzheimer’s Society.
The Main Findings
Key findings from the report include:
- Just 6% of hospitals had a care pathway in place for people with dementia. 44% had a care pathway under development.
- Only 32% of staff reported they felt their training in dementia care was sufficient. Interim audit findings released in 2010 found only 5% of hospitals had mandatory awareness training for staff.
- 50% of staff reported they had not received enough training in communication skills specific to people with dementia, and 54% said they had not received sufficient training in dealing with challenging or aggressive behaviour.
- Few wards had a culture of “person-centred” supportive care which treats the person with dementia as an individual and values their perspective.
- 59% of wards did not attempt to place personal items (such as family photographs or cards) where patients could see them for reassurance.
- Only 15% of ward environments used colour schemes to help patients with dementia find their way around. Only 38% of wards used signs designed to be suitably large, bold and distinctive.
The Main Recommendations
The report makes various recommendations to remedy the situation, including:
- All staff should receive basic training in dementia awareness, and some ward staff should receive a higher level of training.
- Staffing levels should reflect the additional support needs of people with dementia.
- A Senior Clinical Lead for dementia should be in place in each hospital, with the time to develop, implement and review the dementia pathway. These Clinical Leads should identify Dementia Champions in each department and at ward level.
- Ward managers should ensure staff can involve people with dementia and their carers in discussions about care, treatment and discharge.
- Guidance, supervision and support should be available for staff caring for people with dementia.
- Guidance on dementia-friendly ward design should be available from Departments of Health in England and Wales, to be incorporated as standard into refurbishments and new-builds.
- The ward environment for older people should incorporate orientation aids such as colour schemes and personalised bed areas.
Professor Peter Crome, Chair of the National Audit of Dementia Steering Group, said:
“This report provides further concrete evidence that the care of patients with dementia in hospital is in need of a radical shake-up. We have a provided a number of recommendations that if implemented will enable patients and their families to have confidence in their hospital treatment. It is good to see that several hospitals have responded to the results of the interim findings with programmes of quality improvement. Hopefully real change will be seen in the results of the next national audit, which is due to be published in June 2013.”
Read more: National Audit of Dementia.
Royal College of Psychiatrists (2011). Report of the National Audit of Dementia Care in General Hospitals 2011. Full Report. London: Royal College of Psychiatrists’ Centre for Quality Improvement, December 16th 2011.
Note: The report was actually written by John Young, Chloë Hood, Rosemary Woolley, Aarti Gandesha and Renata Souza.
Dementia care ‘lacking’ report finds. London: NHS Choices, December 16th 2011.