National Audit of Dementia (NAD) Context Page

**Please note: updated information pending**

Additional information and more up to date data may be available at www.rcpsych.ac.uk

The National Audit of Dementia is delivered by the Royal College of Psychiatrists and commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England and the Welsh Government. We measure the performance of general hospitals against criteria relating to care delivery which are known to impact people with dementia while in hospital.

These criteria (standards) are from national and professional guidance, including NICE Quality Standards and guidance, the Dementia Friendly Hospitals charter, and reports from the Alzheimer’s Society, Age Concern and Royal Colleges.

Metrics:

1. Percentage of carers rating overall care received by the person cared for in hospital as Excellent or Very Good

• Rationale: This percentage shows how highly carers rate the quality of overall care for people with dementia and helps to provide a proxy viewpoint of the patient experience. Almost 70% of carers across all hospitals rated the overall quality of care highly.
• Guideline/mapping: NICE CG 42, Supporting people with dementia and their carers in health and social care (2006), NICE QS1, Dementia: support in health and social care, 2010, Counting the Cost: Caring for people with dementia on hospital wards, Alzheimer’s Society, 2009.
• Graph/relative performance: Percentile RAG scale; hospitals have been graded according to whether their outcomes fall in the top 25%, bottom 25%, or in the middle range of trusts nationally.
• Quality improvement prompt question: If in the bottom quartile this should prompt questions about what can be done to improve the standard of care for those patients with dementia (this may relate to a wide range of issues including communication with carers, nursing or medical care and so corroboration with other performance measures may be helpful in identifying improvement goals).

2. Percentage of staff responding “always” or “most of the time” to the question “Is your ward/ serviceable to respond to the needs of people with dementia as they arise?”

• Rationale: This percentage shows how staff feel the area of the hospital they work in performs with regard to meeting the needs of people with dementia.78% of all staff responding thought that this happened always or most of the time. 19% said it happened sometimes and 3% that it did not happen.
• Guideline/mapping: Setting Appropriate Ward Nurse Staffing Levels in NHS Acute Trusts. Principles for Appropriate Ward Nurse Staffing. Royal College of Nursing, 2006. Counting the Cost: Caring for people with dementia on hospital wards, Alzheimer’s Society, 2009.
• Graph/relative performance: Percentile RAG scale; hospitals have been graded according to whether their outcomes fall in the top 25%, bottom 25%, or in the middle range of trusts nationally.
• Quality improvement prompt question: If in the bottom quartile this should prompt questions about what can be done to improve the standard of care for those patients with dementia (this may relate to a wide range of issues including communication with carers, nursing or medical care and so corroboration with other performance measures may be helpful in identifying improvement goals).

3. Mental state assessment carried out upon or during admission for recent changes or fluctuation in behaviour that may indicate the presence of delirium

• Rationale: Delirium can affect over a quarter of older patients in hospital and may have long-lasting effects on cognition as well as physical decline. Delirium is five times more likely to affect people with dementia who should have an initial assessment (screen) for any possible signs, followed by a full clinical assessment if necessary. In over half the casenotes overall (55%) there was no evidence of a delirium screen. This may be affected by inconsistencies in how this is recorded by hospitals.
• Guideline/mapping: NICE CG 103 Delirium: prevention, diagnosis and management 1.2.1
• Graph/relative performance: Percentile RAG scale; hospitals have been graded according to whether their outcomes fall in the top 25%, bottom 25%, or in the middle range of trusts nationally.
• Quality improvement prompt question: If in the bottom quartile this should prompt questions about what can be done to improve the consistency of screening for delirium amongst dementia patients.

4. Multi-disciplinary team involvement in discussion of discharge

• Rationale: Input from the healthcare professionals involved in the care of the person with dementia in hospital provides information about their ongoing needs which can be important to a successful discharge.81.5% of casenotes of people with dementia did show that the care team was involved in this discussion
• Guideline/mapping: Hospital Care, Alzheimer’s Society, 2015
• Graph/relative performance: Percentile RAG scale; hospitals have been graded according to whether their outcomes fall in the top 25%, bottom 25%, or in the middle range of trusts nationally.
• Quality improvement prompt question: If in the bottom quartile this should prompt questions about what can be done to improve the involvement of the MDT in discharge processes.