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Hospital care of dementia patients still falling short, national audit shows

Key assessments not done; half of hospital boards don’t track care quality

Caroline White

Friday, 12 July 2013

Many patients with dementia in England and Wales are still not getting the key health assessments they need, while a significant proportion of hospital boards are failing to track the quality of care these patients get, concludes the second report of the National Audit of Dementia, published today.

The findings, which are based on returns from 210 general hospitals—98% of those eligible—and almost 8000 case reports, were collated by the Royal College of Psychiatrists’ Centre for Quality Improvement in partnership with other organisations, including the Royal College of General Practitioners and the Royal College of Nursing.

They show that while many elderly patients with dementia develop acute confusion during their hospital stay, less than half of those in the audit sample had been assessed for delirium, and only half had received an assessment of their mental state. These assessment rates are “alarmingly low,” says the audit report.

A third of hospitals don’t have guidance in place on involving the person’s carer and sharing information with them, the audit shows.

Furthermore, less than half of hospital executive boards are routinely involved in reviewing hospital performance data on the quality of care received by people with dementia, including delayed discharges, readmissions and falls, although this is an improvement on the previous audit’s figures of 25%.

Any instances of discharge after midnight, or when carers/family receive less than 24 hours’ notice, should be reported to, and reviewed by, trust boards, the report recommends.

Furthermore, two in five hospitals don’t provide dementia awareness training to new staff; one in 10 (11%) don’t provide this training to nurses.

The audit shows that patients’ case notes often don’t include information that could aid communication with them, and information needed for future care is not routinely summarised at the point of discharge.

Less than half of those with symptoms of delirium, or with behavioural or psychological symptoms of dementia, including agitation, distress or aggression, during admission had this recorded in their discharge summary. In one in four case notes, there was no record that notice of discharge from hospital had been given to carers or family.

But the report shows that several aspects of care have improved since the first report in 2011.

The overall number of prescriptions of antipsychotic drugs has dropped by 10%, and patients are now more likely to have their nutritional needs assessed.

Hospitals are working to improve the quality of care that people with dementia receive. A third (36%) now have a care pathway in place for people with dementia – up from 6%—and a further 51% have one in development.

All hospitals should have a care pathway in place under the leadership of a senior clinician by June 2014, says the report.

It restates many of the recommendations made in the first audit report and additionally recommends that dignity leads, dementia champions and dementia specialist nurses be deployed in all hospitals, and that a personal information document, such as This is Me, published by the Alzheimer’s Society, should be used throughout every hospital to ensure that staff know what each patient’s individual needs and preferences are.

Ward managers should ensure that there is clear leadership and supervision available to staff on the ward regarding the care of people with dementia, and that this is supported with appropriate training and learning resources, it says.

Commissioners/Health Boards should also ensure that liaison psychiatry services are in place to provide adequate access over 24 hours for treatment and referral of people with dementia in hospital, it recommends.

Professor Peter Crome, Chair of the National Audit of Dementia Steering Group, said he was pleased to see that improvements were being made.

“However, much still needs to be done and there remains a large gap between what hospitals say should happen and what actually does happens,” he said. “Everyone working in the NHS must accept that the care of people with dementia is a core part of its business. Hopefully, with strong leadership at all levels future audit will show further positive change.”

Professor John Young, National Clinical Director for Integration & Frail Elderly and advisor to the National Audit of Dementia, added: “The second round of the National Audit of Dementia has shown that hospitals are at last engaging with the special care requirements necessary to support people with dementia and their families. Important progress has been made across several fronts, but many care gaps remain to be addressed.”

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