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National Audit of Dementia (NAD) Context Page

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.

To view the full audit data set visit RCPSYCH website

Metrics:

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

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?”

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.

 

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