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