Transcript Slide 1

National Audit of Dementia
(care in general hospitals)
Developing standards for audit
Chloë Hood, CCQI
Audit background
What is NAD?
 Established 2008 to examine the quality of care delivered in hospital to
people with dementia
 Open to all general acute hospitals, or those providing general acute
services on more than one ward that admit people over the age of 65, in
England and Wales
Data collection and participation
 Round 1 2010 -11, Round 2 2012-13
 88-98% participation by hospitals (99-100% participation by Trusts/Health
Boards)
Overall finding
 Round 2 showed significant positive change but many best practice
standards remained unmet
Standards for NAD - sources
2 stage literature review
 National guidance
 NICE/ SCIE guideline 42 Supporting people with dementia and their
carers in health and social care; National Dementia Strategy;
DH guidance – NSFs, hospital specific
 Professional guidance
 British Geriatrics Society Comprehensive Assessment;
 Patient and carer representative organisations
 Help the Aged Dignity on the Ward; Age Concern Hungry to be Heard
 Areas of patient/carer priority
 Emphasis on care and support from admission to discharge (dementia
and acute condition); communication and collaboration between
patients, carers and staff; information exchange
Developing audit standards and criteria
Multiple sources for audit standards and criteria
 Key source NICE guideline – highest level, strongly evidenced, best practice,
with expert by experience input
 Use of detailed criteria from guidance developed by professionals and
organisations representing patients and carers, and setting specific
guidance
Example: assessment theme in the audit
 Key source NICE CG 42 (first round of audit March 2010)
 1.1.7.2 Care managers and care coordinators should ensure that
care plans are based on an assessment of the person with
dementia’s life history, social and family circumstance, and
preferences, as well as their physical and mental health needs and
current level of functioning and abilities
Developing audit standards and criteria
Relates to Statement 4 in QS 1
• Quality statement
• People with dementia have an assessment and an ongoing personalised care
plan, agreed across health and social care, that identifies a named care
coordinator and addresses their individual needs.
• Quality measure
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Structure: Evidence of local arrangements to ensure services are tailored to an individual's needs.
Process:
a) Proportion of people with dementia whose individual needs are assessed and whose care plan
states how those needs will be addressed.
Numerator – the number of people with an assessment of individual needs and a care plan
addressing identified needs.
Denominator – the number of people with dementia
b) Proportion of people with a named health or social care coordinator.
Numerator – the number of people with a named health or social care coordinator.
Denominator – the number of people with dementia.
Developing audit standards and criteria
Details for audit in hospital setting
 BGS Comprehensive Assessment of the Frail Older Patient
Domains
Items to be assessed
Medical
Co-morbid conditions and disease severity; Medication Review;
Nutritional status; Problem list
Mental Health
Cognition; Mood and anxiety; Fears
Functional capacity
Basic activities of daily living; Gait and balance; Activity/exercise
status;
Instrumental activities of daily living
Social circumstances
Informal support available from family or friends;
Social network such a visitors or daytime activities;
Eligibility for being offered care resources
Environment
Home comfort, facilities and safety; Use or potential use of telehealth
technology etc;
Transport facilities; Accessibility to local resources
Developing audit standards and criteria
Details for audit in hospital setting
 Alzheimer’s Society Care on a Hospital Ward/ This is Me
Information about the person
contributing to care quality
Examples
Personal details, routines and
preferences
Preferred name; communication; times of rising and
retiring; food preferences...
Support with personal care
Whether the person needs help r reminders with daily
activities, such as washing, dressing, eating and drinking,
mobility...
Anything that might cause upset/ Being alone; noise; family concerns...
distress
What can calm/ support/ make
the person feel better
Conversation; music; reassurance....
Life details to aid communication Family history; loved ones; job/ occupations; hobbies;
favourite places....
Audit standards and questions
Section on assessment
 Overall statement: All people with dementia receive a
comprehensive assessment that includes assessment of their
mental health needs
 19 separate standards derived from multiple sources
 Assessed via
 Organisational checklist (policies and procedures
 Casenote audit (evidence of assessments)
Reporting – evidence of assessments
Comparison shown in National Report
Second round of audit
First round of audit
Mobility
87
Formal pressure sore risk assessment
87
Nutritional status
Patient asked about any continence needs
81
76
Mental status test
43
Functioning (standardised assessment)
10
20
30
87
87
50
44
26
0
94
89
70
Patient asked about the presence of pain
94
40
50
60
70
80
Percentage of case notes
90 100
Reporting – personal information
Percentage of case notes
74% of hospitals now have a system for collecting personal information (up
from 30%). The collection of personal information could be improved,
particularly in areas that could help prevent distress and challenging behaviour
in people with dementia.
100
90
80
71
70
60
55
46
50
34
40
25
30
20
10
0
Personal details,
preferences and
routines
Reminders or
support with
personal care
Recurring factors
Support or
Life details which
that may cause actions that can
aid
or exacerbate calm the person communication
distress
if agitated
Information collected about the person with dementia
Considerations for future reporting
Standards for audit were explicitly linked to NICE guidance
 All standards and criteria were referenced to their key sources
 Local reports gave key sources in each section
Reporting could link in the same way
 We could map the results to NICE quality statements – e.g. Where results
show that people with dementia are not receiving a fully comprehensive
assessment, Quality Statement 4 is not met in the hospital setting
Feasibility will have an impact
 E.g. QS4 specifies auditing care plans to show that they address needs
identified by assessment
 Round 1 of audit found this question had poor reliability – was not
nationally reported