National Audit of Dementia (2010) Core Audit Local Report National Audit of Dementia (Care in General Hospitals) Date: December 2010 National Results: Core Audit Modules 1 National Audit of Dementia (2010) Core Audit Data - All Table of Contents Organisational checklist data 5 Governance 6 Delivery of Care 8 Mental Health Needs 10 Discharge Policy 11 Information 12 Recognition of Dementia 13 Training, Learning and Development 14 Specific Resources 16 Liaison Psychiatry 18 Casenote audit data 20 Demographic Information 21 Assessment 25 Prescription of antipsychotics 30 Continuity of care 32 Discharge 34 Liaison Psychiatry 37 Outcomes 42 Length of stay 44 Record Keeping 45 Appendices A – Inter-rater Reliability Analyses 47 B – Limitations of the Data 54 C – Steering Group and Project Team 55 D – Participating Trusts and Hospitals 56 E – Participation Breakdown by Region 62 2 National Audit of Dementia (2010) Core Audit Data - All National Audit of Dementia (Care in General Hospitals) National results - Core Audit modules The data shown below are the aggregated national results from the two modules comprising the “core audit” of the National Audit of Dementia: i. a hospital organisational checklist to audit the service structures, policies, care processes and key staff that impact on service planning and provision for people with dementia. This part of the audit was carried out between March and May 2010 and involved 210 hospitals. ii. a retrospective casenote audit of the records of 40 patients with a diagnosis or current history of dementia. This compared actual practice with standards that relate to admission, assessment, care planning/delivery, and discharge. The sample of casenotes was of 7934 patients discharged between 1st September 2009 and 28th February 2010, and data was submitted by 206 hospitals. Audit was of a single admission, and eligible admissions were of five days or longer (see Appendix B for more information about casenote samples submitted). Standards in the audit The standards compiled for the audit, together with a full list of source documents, can be found at www.nationalauditofdementia.org.uk Classification of standards in the audit The classification of the standards is in accordance with the following broad principles: Type 1: failure to meet these standards 100% would result in a significant threat to patient safety, rights or dignity and/or would breach the law; Type 2: standards that an organisation/ward would be expected to meet in normal practice; Type 3: standards that an organisation/ward should meet to achieve excellent practice. See standards document available at www.nationalauditofdementia.org.uk 3 National Audit of Dementia (2010) Core Audit Data - All Data collection for the audit The data collection tools (checklists and questionnaires) used to collect data for this audit, together with full guidance provided to participants, are available at www.nationalauditofdementia.org.uk. Data collection schedule Organisational Checklist: Data collection for this part of the audit was carried out between 15 March 2010 and 14 May 2010. Casenote Audit: Data collection for this part of the audit was carried out between 22 May 2010 and 16 July 2010. 4 National Audit of Dementia (2010) Core Audit Data - All Organisational checklist – full presentation of results One checklist was requested from each participating hospital. Data collection for this part of the audit was carried out between 15 March 2010 and 14 May 2010. Key for organisational checklist Related Std Type Q N % questions Total number of ‘yes’ responses (Where The type received from the national sample % of sites relevant) Ref. from of the Text of the question from for this question Question number responding Shows related standards standard audit tool, with possible / from audit tool yes to this questions in for audit (see responses (e.g. Y/N/NA) Total number of responses received question casenote audit page 3) from the national sample for this tool question * * Excludes N/A answers. Some totals are less due to question routing. 5 National Audit of Dementia (2010) Core Audit Data - All Section 1 – Governance Related Std Type Q N % questions A care pathway for patients with dementia is in place 4.1 2 1 12/210 5.7 - (Y/N/In Development) Number answering “In development” 92/210 43.8 - (response for q1 only) A senior clinician is responsible for implementation and/ or 4.2 2 1a 92/140 65.7 - review of the care pathway (Y/N/NA) There is a named officer with designated responsibility for 4.3 1 2 200/210 95.2 - the protection of vulnerable adults (Y/N) The Executive Board regularly reviews information collected 3 on: 4.7 2 3a Re-admission of patients with dementia (Y/N) 16/210 7.6 - 4.7 2 3b Delayed transfers of people with dementia (Y/N) 41/210 19.5 - The Executive Board regularly reviews the number of in- hospital falls and breakdown of the immediate causes, and 4.4 2 4 66/210 31.4 - patients with dementia can be identified within this number (Y/N) The Executive Board regularly receives feedback from the 5 following: The Clinical Leaders for older people and people with 4.5 2 5a dementia including Modern Matrons/Nurse Consultants 100/210 47.6 - (Y/N) 4.5 2 5b Complaints – analysed by age (Y/N) 88/210 41.9 - PALS – in relation to the services for older people and 4.5 2 5c 78/210 37.1 - people with dementia (Y/N) Patient Forums or Local Involvement Networks – in relation 4.5 2 5d to the services for older people and people with dementia 68/210 32.4 - (Y/N) There is a process in place to regularly review hospital 4.8 2 6 discharge policy and procedures, as they relate to people 63/210 30 - with dementia (Y/N) 6 National Audit of Dementia (2010) Core Audit Data - All Related Std Type Q N % questions Nursing staff have access to a recognised process to record 4.9 2 7 and report risks to patient care if they believe ward staffing 207/210 98.6 - is inadequate (Y/N) Audit (within the hospital) includes the percentage of people with suspected dementia for whom structural 4.10 3 8 imaging, computed tomography (CT), scanning or magnetic 18/210 8.6 - resonance imaging (MRI) has been undertaken as part of assessment and diagnosis (Y/N) There is a reporting mechanism to gather information on maximum response time to obtain specialist assessment in 9 the following situations (tick N/A if there is no older people’s multidisciplinary team): Access to an older people’s multidisciplinary team in A&E/ 4.6 2 9a 55/162 34 - MAU (Y/N/NA) Access to an older people’s multidisciplinary team in non- 4.6 2 9b 45/164 27.4 - elderly care wards (Y/N/NA) Access to an older people’s multidisciplinary team for older 4.6 2 9c 74/171 43.3 - people with mental health problems (Y/N/NA) 7 National Audit of Dementia (2010) Core Audit Data - All Section 2 – Delivery of Care Std Type Q N % Related questions 10a Multidisciplinary assessment includes: 1.9 1 10a1 Problem list (Y/N) 188/210 89.5 2 Co morbid conditions (Y/N) 1.9 1 10a2 200/210 95.2 2a 1.9 1 10a3 Full current medication (Y/N) 204/210 97.1 2b,2c 1.9 1 10a4 Nutritional status (Y/N) 202/210 96.2 2e Assessment of functioning using a standardised instrument 1.9 1 10a5 – i.e. basic activities of daily living, instrumental activities 176/210 83.8 2d, 6 of daily living, mobility (Y/N) Assessment of mental state – i.e. mental status (cognitive) 1.3 2 10a6 testing, mood (depression) testing (Y/N) 155/210 73.8 7, 7b Assessment includes social assessment – i.e. care input, 1.16 2 10b voluntary agency support, family support, financial support 202/210 96.2 8, 8a, 8b (Y/N) Assessment includes environmental assessment – i.e. 1.17 2 10c safety in the home environment, transportation needs 192/210 91.4 8c (Y/N) As part of initial assessment, patients are weighed on 1.9 1 11 186/210 88.6 2e1 admission (Y/N) As part of initial assessment, patients’ height is measured 1.9 1 12 on admission (Y/N) 89/210 42.4 2e2 Protected mealtimes are established in all wards that admit 3.7 1 13 frail elderly people (75+) (Y/N) 194/210 92.4 - There are policies or guidelines in place to ensure that patients with dementia or cognitive impairment are 1.4 2 14 70/210 33.3 7a screened for delirium, using a standardised method (e.g. Confusion Assessment Method (CAM)) (Y/N) 8 National Audit of Dementia (2010) Core Audit Data - All Related Std Type Q N % questions The care pathway for people with dementia interfaces with 1.19 2 15 the palliative care pathway to ensure that people with 50/106 47.2 - dementia have equal access to palliative care (Y/N/NA) The care pathway for people with dementia interfaces with 3.5 2 16 the end of life care pathway to ensure that people with 60/100 60 - dementia have equal access to end of life care (Y/N/NA) The end of life care pathway specifies that the health care team and consultant/ consultant nurse discuss any issues to do with end-of-life care with the patient and 3.6 2 17 carers/relatives (including resuscitation and any advance 173/193 89.6 - decisions made by the person with dementia) (Y/N/NA) 9 National Audit of Dementia (2010) Core Audit Data - All Section 3 – Mental Health Needs Q Related Std Type N % questions There are systems in place to ensure that where dementia is suspected but not yet diagnosed, this triggers a referral 1.1 2 18 for assessment compliant with NICE guidance either in 102/210 48.6 - hospital or in the community (memory service) (Y/N) An assessment of mental state is carried out on all 1.2 2 19 patients over the age of 65 admitted to hospital (Y/N) 58/210 27.6 7 There is a protocol in place governing