The National Audit of Dementia, by the Royal College of Psychiatrists, which has looked at data from 210 hospitals across England and Wales, and included a review of case notes for 8,000 patients with dementia, has found some improvements since the first audit of care in England and Wales in 2011. There has been a 10% drop in the prescription of antipsychotic drugs, and patients are more likely to receive a nutritional assessment.
Many patients showing signs of dementia or delirium upon being admitted to hospital do not receive the proper checks, and when patients do have their mental state assessed this information is not always shared properly.
One third of hospitals do not have guidance available to staff on involving the patient’s family / carer and how to share information. Patient notes often do not include information which could help staff to communicate with them, and sometimes include poor discharge information.
Forty percent of hospitals do not provide dementia awareness training to new staff, and less than half of hospital executive boards review routinely hospital performance data on the quality of care received by people with dementia.
Read more: BBC News: Dementia patients ‘miss key tests’.
Dementia patients ‘miss key tests’. London: BBC Health News, July 12th 2013.
This relates to:
Royal College of Psychiatrists (2013). National Audit of Dementia care in general hospitals 2012-13: second round audit report and update. Editors: Young, J. Hood, C. Gandesha, A. and Souza, R. London: Healthcare Quality Improvement Partnership (HQIP), June 12th 2013.
Second Round Audit Report and Update to the National Audit of Dementia Care in General Hospitals 2012-13: Summary Points
41% of hospitals do not provide dementia awareness training during staff induction.
40% of hospitals do not provide dementia awareness training to support staff, and 11% do not provide dementia awareness training to nurses.
36% of hospitals have a care pathway for people with dementia; up from 6% from 2011. 51% of hospitals have a care pathway in development.
Less than 50% of hospital executive boards review routinely hospital performance data on delayed discharges, readmissions and falls, relating to people with dementia; up from less than 25% of boards reviewing this information in 2011.
Important information is not provided at discharge. Less than half of the patients with symptoms of delirium or BPSD (including agitation, distress or aggression) during admission have this recorded in their discharge summaries.
One quarter of casenotes do not record that notice of discharge from hospital has been given to carers or family.
Case notes often lack information which could help staff communicate better with the patient. Information helpful to future care is not summarised routinely at hospital discharge.
The updated National Audit of Dementia recommends all hospitals should have a care pathway, with the leadership of a senior clinician, by June 2014. Other recommendations in the second report include:
Dignity leads, dementia champions and dementia specialist nurses should be employed in all hospitals.
Ward managers should provide clear leadership and supervision regarding the care of people with dementia, supported with appropriate training and learning resources.
A skills gap analysis is needed in each hospital, across different staff groups, in order to create a local action plan.
A personal information document (such as the “This is Me” or “About Me” summary) should be used throughout hospitals to ensure that staff are aware of patients’ individual needs and preferences.
Instances of discharge of people with dementia from hospital after midnight, and cases of carers / family receiving less than 24 hours notice prior to discharge, should be reviewed by Trust Boards.
Audits of in-hospital antipsychotic prescribing should be carried out routinely, to assist comparisons between wards and departments.
Directors of Nursing should review protected mealtimes in their hospitals.
[A version of this item features in Dementia: the Latest Evidence Newsletter (RWNHST), Volume 3 Issue 8, July 2013].