National audit of dementia

Royal College of Psychiatrists National Audit of Dementia pages

Dementia report 2017: key recommendations

These are the key recommendations from the National Audit of Dementia Care in General Hospitals 2016-17.

There’s a full list of recommendations on page 87 of the full report (pdf) and the report also details recommendations on a theme by theme basis.

Delirium

Medical and nursing directors should ensure that hospitals have robust mechanisms in place for assessing delirium in people with dementia including:

• At admission, a full clinical delirium assessment, whenever indicators of delirium are identified
• Cognitive tests administered on admission and again before discharge
• Delirium screening and assessment fully documented in the patient’s notes (regardless of the outcome)
• Care offered in concordance with the delirium evidence-base recommendations when the assessment indicates symptoms of delirium.
• Results recorded on the electronic discharge summary
• Ensure staff receive training in delirium and its relationship to dementia, manifestations of pain, and behavioural and psychological symptoms of dementia.

Personal information use

National Commissioners (Welsh Government, NHS England) should propose a nationally backed monitoring programme aimed at embedding the collection, sharing and use of person centred information.

This should include a clear expectation that once gathered, this information will follow the patient between providers, and this will be monitored.

Ward managers should audit implementation/use of personal information collected to improve care for patients (e.g. This is Me or other locally developed document). The result of the audit should be fed back to the dementia champions/dementia lead and ward staff.

Nutrition

• Clinical Commissioning Groups and Health Board commissioning services should ensure that tenders let by Trusts for new catering contracts always specify provision of finger foods for main meals and access to a range of snacks 24 hours a day.
• Medical and Nursing Directors should promote the attendance of key carers to support care, but ensure that this is complementary to, and not instead of, care delivered by staff. The level of input by carers, and how carers feel about the level of input they have been asked to deliver should be monitored through carer feedback, complaints and PALS enquiries. Carer satisfaction should be seen as a marker of good care. Ward managers should be supported to ensure carers supporting patients should not be asked to leave at mealtimes/stopped from helping with meals (this excludes emergency and urgent care and treatment).

Dementia champions

The Chief Executive Officer should ensure that there is a dementia champion available to support staff 24 hours per day, 7 days per week. This could be achieved through ensuring that people in roles such as Site Nurse Practitioners and Bed Managers have expertise in dementia care.

Decision making

The Safeguarding Lead should ensure that staff are trained in the Mental Capacity Act, including consent, appropriate use of best interests decision making, the use of Lasting Power of Attorney and Advance Decision Making. Training should cover supportive communication with family members/carers on these topics.