National Audit of Dementia Care in General Hospitals

Transcription

1 National Audit of Dementia Care in General Hospitals Local report appendices for: Luton & Dunstable Hospital Luton and Dunstable University Hospital NHS Foundation Trust July 2017 Commissioned by:

2 Many thanks to Hwyl for permission to use the cover artwork. Hwyl is an art project run by Dementia Matters in Powys (DMiP) and Arts Alive Wales based at the Brecon War Memorial Hospital. The project focuses on working with elderly patients on wards, with their families, carers, the ward staff and artists on a weekly basis. With thanks to Rhiannon Davies (DMiP) and Tessa Waite (Arts Alive Wales).

3 Table of Contents Introduction to the appendices... 2 Appendix A: Organisational checklist data... 3 Appendix B: Patient demographics Appendix C: Casenote audit data Appendix D: Carer demographics Appendix E: Carer questionnaire data Appendix F: Staff demographics Appendix G: Staff questionnaire data Appendix H: Verbatim staff suggestions for your, presented by job role National Audit of Dementia Round 3 Luton & Dunstable Hospital 1

4 Introduction to the appendices This is the appendices for your local report. local report is in a separate document. The appendices present data from Round 3 of the National Audit of Dementia, both at a national level and for your. Data for your in Round 2 is also shown where applicable. When comparing Round 2 data with Round 3 data, please be aware that differences in sample sizes and slight wording changes to some questions, can affect results in both rounds. Therefore, conclusions made from comparing the data should be with caution. Hospitals with less than five returns for the carer or staff questionnaires have not received any data and returns of 5 to 9 questionnaires have not received demographic information. The table below shows how the data tables in the appendices are laid out and what information you can find in each cell. Std no. Question number and text National audit Standard reference and type. Standards document can be found on the audit website. Question number. Orange items in the casenote audit appendix show low interrater reliability. Question wording as in tool. The national audit refers to all s from England and Wales that participated in the Round 3 audit. Data for your from Round 3. If the same question or a similar question was asked in Round 2, we have provided your Round 2 response for comparison. The carer and staff questionnaires are new tools and therefore this column has been excluded in these appendices. We have provided the percentage yes response (unless otherwise indicated) and the numerator/denominator. The denominator will change throughout the appendices, depending on whether questions were routed (not asked in some instances), N/A responses were chosen (these have been excluded from the analyses), or where staff and carers did not respond. For the organisational checklist, data from 199 s are included in the national audit column (all the registered participants). 195 s participated in the casenote audit, returning casenotes and this is shown in the national audit column. The national audit column for the casenote audit also shows the median and the inter quartile range for each question (where applicable). Question items which were found to have lower agreement in the interrater reliability analysis (see audit website) have been coloured orange. 196 s returned carer questionnaires. Data from all questionnaires (4664) is presented in the carer questionnaire data tables in Appendix E. 198 s returned staff questionnaires. Data from all questionnaires (14416) is presented in Appendix G. For some questionnaire items, the data for the two most positive answers have been combined, as well as being presented separately. This is provided both at a national level and for your. National Audit of Dementia Round 3 Luton & Dunstable Hospital 2

5 Appendix A: Organisational checklist data Governance and delivery of care Std no a 1b National audit A care pathway or bundle for patients with dementia is in place: In development (If Q1= or In development) A senior clinician is responsible for implementation and/ or review of the care pathway: (y/n) / / /173 (If Q1= or In development) The dementia care pathway/ bundle is integrated within or linked to the following care pathways: Pathway in development Pathway in development Pathway in development Delirium Stroke / / / /173 Fractured neck of femur / /172 2 The Executive Board regularly reviews information collected on: 2a 2b 3 Readmissions, in which patients with dementia can be identified in the total number of patients readmitted (y/n) Delayed discharge/ transfers, in which patients with dementia can be identified in the total number of patients with delayed discharge/ transfers (y/n) The Executive Board regularly reviews the number of in falls and the breakdown of the immediate causes, in which patients with dementia can be identified (y/n) / / /199 N/A New question for Round 3 New question for Round 3 New question for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 3

6 Std no N4a [3] N4b [3] National audit 4 The Executive Board regularly receives feedback from the following: 4a 4b Clinical Leads for older people and people with dementia including Modern Matrons/ Nurse Consultant (y/n) Complaints analysed by age (y/n) Patient Advice and Liaison Services (PALS) in 4c relation to the services for older people and people with dementia (y/n/na (s in Wales)) Patient/ public forums or local Healthwatch in 4d relation to services for older people and people with dementia (y/n) 5 There are champions for dementia at: 5a 5b Directorate level (y/n) Ward level (y/n) Dementia specialist nurses are employed in line with Royal College of Nursing guidance (there is at least one full time dementia specialist nurse for every 300 admissions of people with dementia per year): (y/n) Has a strategy or plan for carer engagement been produced (e.g. using Triangle of Care selfassessment tool)? (y/n) / / / / / /199 This question is not reported on as feedback showed s found it difficult to interpret /199 (If Q7=) Is implementation of the strategy or plan scheduled for review? 41.2, more than once a year 63/153, once a year, less than once a year / /153, less than once a year New question for Round 3 New question for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 4

7 Std no. National audit 9 A Dementia Working Group is in place and reviews the quality of services provided in the : (y/n) /199 New question for Round 3 (If Q9=) The group meets: Annually 0.5 1/186 Biannually 0.5 1/186 Quarterly /186 N4c [3] 9a Sixweekly Monthly Bimonthly 4.3 8/ / /186 Bimonthly New question for Round 3 Weekly 0.5 1/186 Unknown 1.6 3/186 (If Q9=) The group includes: 9b Healthcare professionals Organisations e.g. Alzheimer s Society / /186 New question for Round 3 Carer/ service user representation /186 N7a [3] Ward staffing levels (nurses, midwives and care staff) are made available for the public to view on a monthly basis: (y/n) An evidencebased tool is used for establishing ward staffing levels: (y/n) / /199 New question for Round 3 New question for Round a Protected mealtimes are established in all wards that admit adults with known or suspected dementia: (y/n) (If Q12=) Wards adherence to protected mealtimes is reviewed and monitored: (y/n) / / The has in place a scheme/ programme which allows identified carers of people with dementia to visit at any time including at mealtimes (e.g. Carer s Passport): (y/n) /199 New question for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 5

8 Discharge and transfer monitoring Std no. N5a [3] N3c [3] National audit Instances where less than 24 hours notice of discharge has been given to carers or family are compiled and reported to the Executive Board:, within the past 6 months, within the last year Instances of night time bed moves (i.e. between the evening meal and breakfast the next morning) are noted and reported at Executive Board level: (y/n) 4 8/ / /199 New question for Round 3 New question for Round 3 Use of personal information documents Std no. National audit 16 There is a formal system (proforma or template) in place in the for gathering information pertinent to caring for a person with dementia: (y/n) /199 17a (If Q16=) Information collected by the proforma includes personal details, preferences and routines: (y/n) / b (If Q16=) Information collected by the proforma includes reminders or support with personal care: (y/n) /196 17c (If Q16=) Information collected by the proforma includes recurring factors that may cause or exacerbate distress: (y/n) /196 17d (If Q16=) Information collected by the proforma includes support or actions that can calm the person if they are agitated: (y/n) / [3] 17e (If Q16=) Information collected by the proforma includes life details which aid communication: (y/n) / (If Q16=) Information collected by the proforma includes how the person with dementia communicates with others/ understands communication: (y/n) /196 New question for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 6

9 Std no (If Q16=) The form prompts staff to approach carers or relatives to collate necessary information: (y/n) National audit /196 Documenting use of personal information in practice: Hospitals selected three wards (not mental health wards) which had the highest admissions of people with dementia. 10 patients in these wards were checked to see if the personal information document was present. Included were patients with dementia who needed a personal information document such as This is Me (any patients with dementia who did not require a personal information document were excluded). Ward 1: ward 14 New Ward 2: ward 15 question for Ward 3: ward 18 Round 3 Number of patients checked: 16 New question for Round 3 Range 040 Median 10 Number of these patients where the information was present: Percentage of patients where the information was present: New question for Round 3 New question for Round 3 Range 0100 Mean 49 Median 50 Recognition of dementia Std no. National audit There is a system in place across the that ensures that all staff in the ward or care area are aware of the person's dementia or condition and how it affects them: (y/n) /199 National Audit of Dementia Round 3 Luton & Dunstable Hospital 7

10 Std no. National audit (If Q21=) Please say what this is: A visual indicator, symbol or marker /180 21a Alert sheet or electronic flag A box to highlight or alert dementia condition in the notes or care plan / /180 Other Other / There is a system in place across the that ensures that staff from other areas are aware of the person's dementia or condition whenever the person accesses other treatment areas: (y/n) /199 (If Q22=) Please say what this is: A visual indicator, symbol or marker /140 N/A 22a Alert sheet or electronic flag A box to highlight or alert dementia condition in the notes or care plan / /140 N/A N/A Alert sheet Other /140 N/A The dementia lead or dementia working group collates feedback from carers on the written and verbal information provided to them: (y/n) /199 New question for Round 3 Training, learning and development Std no. National audit There is a training and knowledge framework or strategy that identifies necessary skill development in working with and caring for people with dementia: (y/n) /199 National Audit of Dementia Round 3 Luton & Dunstable Hospital 8

11 Std no National audit The following questions are about training that is provided to acute healthcare staff who are involved in the care of people with dementia (or suspected dementia): Dementia awareness training: Mandatory Provided on induction Provided in the last 12 months t provided in the last 12 months Mandatory Provided on induction Provided in the last 12 months t provided in the last 12 months Mandatory Provided on induction Provided in the last 12 months t provided in the last 12 months Mandatory Provided on induction Doctors Nurses / / / / / / / /199 Healthcare assistants / / / /199 Other allied healthcare professionals, e.g. physiotherapists, dieticians Provided in the last 12 months t provided in the last 12 months / / / /199 National Audit of Dementia Round 3 Luton & Dunstable Hospital 9

12 Std no [3] 7.5 [3] Mandatory Provided on induction National audit Support staff in the, e.g. housekeepers, porters, receptionists Provided in the last 12 months t provided in the last 12 months Involvement of people with dementia and carers and use of their experiences is included in the training for ward staff: (y/n) / / / / /199 What format is used to deliver basic dementia awareness training? elearning module /199 Workshop or study day /199 Higher education module /199 Other /199 New question for Round [3] N7b [3] Hospitals were asked to provide figures on the number of staff trained in dementia awareness. Only 34 s could provide this for at least one of the years specified. Therefore, there is no data on training figures. What is the total number of adult beds excluding maternity and mental health beds in your at 31 March 2016? This information was to compare with question 28 so is therefore not included. National Audit of Dementia Round 3 Luton & Dunstable Hospital 10

13 Specific resources supporting people with dementia Std no. National audit The has access to intermediate care services, which will admit people with dementia: (y/n) / [3] 30a (If Q30=) Access to intermediate care services allows people with dementia to be admitted to intermediate care directly and avoid unnecessary admission: (y/n) / There is a named dignity lead to provide guidance, advice and consultation to staff: (y/n) / There is a named person/ identified team who takes overall responsibility for complex needs discharge and this includes people with dementia: (y/n) / a (If Q32=) This person/ team has training in ongoing needs of people with dementia: (y/n) / [3] 33b (If Q32=) This person/ team has experience of working with people with dementia and their carers: (y/n) / There is a social worker or other designated person or team responsible for working with people with dementia and their carers, and providing advice and support, or directing to appropriate organisations or agencies: (y/n) /199 National Audit of Dementia Round 3 Luton & Dunstable Hospital 11

14 Std no. N3b National audit The can provide finger foods for people with dementia (please select one option only): Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery (finger food) on every day Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on four to six days per week or more Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on two or three days per week or more Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on only one day per week Finger food consists of sandwiches/wraps only Patients who may be unable to use cutlery will never be admitted to the / / / / / /199 New question for Round 3 The can provide 24 hour food services for people with dementia (please select one option only): In addition to the main meals, other food, for example toast, sandwiches, cereals, soup, and lighter hot dish(es) are available 24 hours a day In addition to the main meals, other food, for example toast, sandwiches, cereals, soup are available, but less than 24 hours a day Simple food supplies for example bread, cereal, yoghurt and biscuits are available 24 hours a day Only snacks (biscuits, cake) are available 24 hours a day Food is not available 24 hours a day There is access to advocacy services with experience and training in working with people with dementia: (y/n) / / / / / /199 New question for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 12

15 Environment Std no [3] N8a [3] National audit Opportunities for social interaction for patients with dementia are available (e.g. to eat/ socialise away from their bed area with other patients): On all adult wards On care of the elderly wards Other / / / /199 New question for Round 3 The physical environment within the has been reviewed using an appropriate tool (e.g. King s Fund Enhancing the Healing Environment) to establish whether it is dementiafriendly : Throughout the All adult wards/ areas All care of the elderly wards/ areas Designated dementia wards only Other / / / / / /199 (If Q39=) Environmental changes based on the review are: Completed Underway Planned but not yet underway Planned but funding has not been identified Plans are not in place 15 27/ / / / /180 New question for Round 3 New question for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 13

16 Std no. N8a [3] 41 National audit (If Q39=) Service users/ carers/ lay volunteers have been part of the team reviewing the environment: Throughout the All adult wards/ areas All care of the elderly wards/ areas Designated dementia wards only Other They have not been part of the team / / / / / /180 (If Q39=) There are plans to further review the changes implemented: New question for Round 3 42, we are already undertaking/ have already done this, once the work is completed / /180 New question for Round 3 plans are in place /180 National Audit of Dementia Round 3 Luton & Dunstable Hospital 14

17 Appendix B: Patient demographics Age range National audit (N) (N) (221) 0 (0) (2445) 26 (13) (7332) 74 (37) (39) 0 (0) Unknown 0.1 (10) 0 (0) Age National audit (N) (N) Range Mean Median Gender National audit (N) (N) Male 40.1 (4029) 44 (22) Female 59.9 (6018) 56 (28) Ethnicity National audit (N) (N) White/ White British 82.1 (8250) 88 (44) Black/ Black British 1.2 (123) 0 (0) Asian/ Asian British 1.9 (193) 0 (0) Chinese 0.1 (10) 0 (0) Mixed 0.1 (11) 0 (0) t documented 2.1 (210) 4 (2) Other 12.4 (1250) 8 (4) First language National audit (N) (N) English 77.4 (7778) 94 (47) Welsh 0.6 (61) 0 (0) Other European language 1 (96) 4 (2) Asian language 1.4 (144) 0 (0) t documented 19 (1909) 2 (1) Other 0.6 (59) 0 (0) National Audit of Dementia Round 3 Luton & Dunstable Hospital 15

18 Primary diagnosis/ cause of admission* National audit (N) (N) Respiratory 19.9 (1998) 26 (13) Fall 13.3 (1332) 8 (4) Urinary/ renal 9 (901) 8 (4) Hip dislocation/ hip fracture 7.5 (754) 10 (5) Sepsis 6.3 (633) 12 (6) Delirium/ confusion 6 (604) 4 (2) Gastrointestinal 5.9 (595) 8 (4) Cardiac/ vascular 5.1 (517) 4 (2) Stroke 3.8 (380) 6 (3) Neurological 3.6 (364) 4 (2) Skin lacerations/ lesions 2 (204) 0 (0) Impaired consciousness 2 (198) 4 (2) Dementia** 1.9 (195) 0 (0) Other 1.9 (192) 0 (0) Unable to cope/ frailty 1.6 (160) 0 (0) Dehydration 1.4 (143) 2 (1) Haematology 1.1 (115) 2 (1) Endocrine/ metabolic 1.1 (112) 2 (1) Other fractures 1 (96) 0 (0) Cancer 0.9 (94) 0 (0) Surgical/ nonsurgical procedure 0.9 (86) 0 (0) Pain/ swelling 0.8 (85) 0 (0) Hepatology 0.8 (84) 0 (0) Oral/ visual/ auditory 0.4 (45) 0 (0) Rheumatic 0.4 (45) 0 (0) Psychiatric 0.4 (42) 0 (0) Adverse reaction to medication/ allergy/ overdose 0.3 (28) 0 (0) Injury/ trauma 0.2 (24) 0 (0) t documented/ unknown 0.2 (21) 0 (0) *Primary cause of admission was taken as the first reason entered on the casenote audit. **Out of 195 noted with Dementia as cause of admission, 142 of these had dementia as the only cause of admission. National Audit of Dementia Round 3 Luton & Dunstable Hospital 16

19 Speciality of the ward patients spent the longest time in National audit (N) (N) Care of the Elderly/ Complex Care 41.1 (4125) 60 (30) General Medical 23.5 (2359) 18 (9) Other Medical 9.9 (999) 0 (0) Orthopaedics 8.9 (892) 8 (4) Surgical 6.8 (681) 6 (3) Stroke 4.5 (456) 8 (4) Cardiac 2.5 (248) 0 (0) Other 1.4 (136) 0 (0) Nephrology 0.5 (52) 0 (0) Obstetrics/ Gynaecology 0.4 (41) 0 (0) Critical Care 0.2 (23) 0 (0) Oncology 0.2 (22) 0 (0) Unknown 0.1 (13) 0 (0) Patients who: National audit (N) (N) Died in 12.8 (1285) 18 (9) Selfdischarged from 0.1 (12) 2.4 (1) Were marked fast track discharge / discharge to assess / transfer to assess / expedited with family agreement for recorded reasons Received end of life care in / was on an end of life care plan 5.5 (482) 7.5 (3) 13 (1302) 20 (10) Length of stay in the National audit (N) (N) 2 10 days 45.3 (4553) 48 (24) days 25.5 (2559) 36 (18) days 11.3 (1132) 12 (6) days 6.7 (671) 2 (1) days 4.2 (418) 2 (1) days 2.3 (230) 0 (0) days 1.7 (168) 0 (0) days 1 (102) 0 (0) days 0.6 (62) 0 (0) More than 90 days 1.5 (152) 0 (0) National Audit of Dementia Round 3 Luton & Dunstable Hospital 17

20 Length of stay in the National audit (N) (N) Range Median (days) Place of residence before/ after admission National audit (N) (N) Before After* Before After* Own home 57.7 (5793) 40.2 (3519) 52 (26) 46.3 (19) Respite care 0.8 (80) 1.6 (136) 6 (3) 4.9 (2) Rehabilitation 0.4 (37) 2.4 (207) 0 (0) 0 (0) Psychiatric ward 0.5 (48) 0.7 (62) 0 (0) 0 (0) Carer s home 2.1 (212) 2.1 (181) 4 (2) 4.9 (2) Intermediate care 0.3 (27) 2 (172) 0 (0) 0 (0) Residential care 16.9 (1701) 17.7 (1551) 26 (13) 19.5 (8) Nursing home 19.7 (1981) 28.7 (2511) 10 (5) 19.5 (8) Palliative care 0 (5) 0.6 (54) 0 (0) 0 (0) Transfer from another 1.4 (145) 3.9 (343) 0 (0) 2.4 (1) Long stay care 0.2 (18) 0.3 (26) 2 (1) 2.4 (1) Change in residence* National audit (N) (N) change 73.4 (6428) 75.6 (31) Own/ carer s home to nursing/ residential care 11.1 (972) 4.9 (2) *These figures exclude patients who died while in. National Audit of Dementia Round 3 Luton & Dunstable Hospital 18

21 Std no Appendix C: Casenote audit data Assessment Multidisciplinary assessment a An assessment of mobility was performed by a healthcare professional: (y/n/could not be assessed for recorded reasons) An assessment of nutritional status was performed by a healthcare professional: (y/n/could not be assessed for recorded reasons) National audit (Median, IQR) /9126 (96, 9198) /9837 (93, 8696) 85 34/ / / /36 (If Q15=) The assessment of nutritional status includes recording of BMI (Body Mass Index) or weight:, there is a recording of the patient s BMI or weight Other action taken or other action taken Has a formal pressure ulcer risk assessment been carried out and score recorded? (y/n) As part of the multidisciplinary assessment has the patient been asked about any continence needs? (y/n/could not be assessed for recorded reasons) As part of the multidisciplinary assessment has the patient been assessed for the presence of any pain? (y/n/could not be assessed for recorded reasons) /8822 (89, 7996) 4 352/8822 (2, 05) /2288 (93, 8598) /10044 (98, 94100) /9744 (92, 8597) /9840 (90, 7798) / / /42 New answer options for 92.9 Round 3 39/ / / / / / /36 National Audit of Dementia Round 3 Luton & Dunstable Hospital 19

22 Std no. National audit (Median, IQR) Has an assessment of functioning been carried out?, a standardised assessment has taken place /9294 (45, 2366) / / , an occupational therapy and/or a physiotherapy assessment has taken place, other /9294 (44, 2658) /9294 (0, 02) /45 0 0/45 New answer options for Round 3 (all options) /9294 (92, 8596) /45 Std no Mental state assessment a Has a standardised mental status test been carried out? (y/n/could not be assessed for recorded reasons) National audit (Median, IQR) /8682 (55, 3872) / /32 Has an assessment been carried out for recent changes or fluctuation in behaviour that may indicate the presence of delirium?, and there were indications that delirium may be present, but there was no indication that delirium may be present (both options) (If Q21=) Has the patient been clinically assessed for delirium by a healthcare professional? (y/n) /10047 (24, 1436) /10047 (15, 625) /10047 (42, 2760) /2603 (90, 78100) 20 10/ / / / / / / /10 National Audit of Dementia Round 3 Luton & Dunstable Hospital 20

23 Std no Information about the person with dementia 22 22a 22b 22c 22d Does the care assessment contain a section dedicated to collecting information from the carer, next of kin or a person who knows the patient well? (y/n) National audit (Median, IQR) /10010 (58, 3185) 94 47/ /40 (If Q22=) Has information been collected about the patient regarding personal details, preferences and routines? Unknown* /5626 (53, 3077) /5626 (14, 044) / /47 (If Q22=) Has information been collected about the patient's food and drink preferences? Unknown* /5616 (50, 2971) /5616 (16, 348) / / /24 New answer option for Round 3 New question for Round 3 (If Q22=) Has information been collected about the patient regarding reminders or support with personal care? Unknown* /5631 (64, 4280) /5631 (13, 037) 34 16/ / /23 New answer option for Round 3 (If Q22=) Has information been collected about the patient regarding recurring factors that may cause or exacerbate distress? Unknown* /5583 (35, 1856) /5583 (20, 550) / / /19 New answer option for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 21

24 Std no [3] 22e 22f National audit (Median, IQR) (If Q22=) Has information been collected about the patient regarding support or actions that can calm the person if they are agitated? Unknown* /5539 (26, 1350) /5539 (20, 752) / /46 (If Q22=) Has information been collected about the patient regarding life details which aid communication? Unknown* /5598 (50, 2570) /5598 (17, 346) / /47 *Unknown response options refer to situations in which the information is usually recorded in a document which accompanies the patient (e.g. This is Me or patient passport) and no copy is available in the notes /12 New answer option for Round /16 New answer option for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 22

25 Discharge Assessment before discharge Std no. National audit (Median, IQR) 23 At the point of discharge the patient's level of cognitive impairment, using a standardised assessment, was summarised and recorded: (y/n) /7329 (17, 930) / /34 (If 23=) Please comment: Patient too unwell/ not responsive / /27 23a Patient has advanced dementia (i.e. patient s advanced dementia makes the assessment not appropriate) t routine/ not standard practice / / /27 0 0/27 New question for Round 3 t documented/ unknown reason / / Dementia diagnosis (i.e. dementia diagnosis mentioned as a reason for not completing assessment) At the point of discharge the cause of cognitive impairment was summarised and recorded: (y/n) / /7329 (72, 5784) 7.4 2/ / /34 25 Have there been any symptoms of delirium? (y/n) /7329 (33, 2241) / /34 25a (If Q25=) Have the symptoms of delirium been summarised for discharge? (y/n) /2367 (45, 3364) / /11 26 Have there been any persistent behavioural and psychiatric symptoms of dementia (wandering, aggression, shouting) during this admission? (y/n) /7329 (19, 1326) 8.8 3/ /34 26a (If Q26=) Have the symptoms of behavioural and psychiatric symptoms of dementia been summarised for discharge? (y/n) /1426 (40, 2360) / /7 National Audit of Dementia Round 3 Luton & Dunstable Hospital 23

26 Std no a (i) 27a (ii) 27a (i) 27a (iii) 27a (ii & iii) Is there a recorded referral to a social worker for assessment of housing and care needs due to a proposed change in residence? (If Q27=): There are documented concerns about the patient s capacity to consent to the referral: The patient had capacity on assessment and their consent is documented The patient lacked requisite capacity and evidence of a best interests decision has been recorded There is no record of either consent or best interest decision making* There are no documented concerns about the patient s capacity to consent to the referral: The patients consent was requested and this is recorded There is no record of the patients consent* Consent or best interests (responses options combined) consent or best interests (response options combined) National audit (Median, IQR) /2519 (71, 5389) /1649 (75, 5089) /1161 (0, 020) /1161 (75, 5090) /1161 (14, 033) /1649 (25, 1150) /488 (25, 050) /488 (75, 50100) /1649 (67, 5086) /1649 (33, 1450) 75 12/ / /8 75 6/ / / /4 75 3/ / /12 New question for Round 3 New question for Round 3 *Please note that these figures include 1.9 of casenotes where it was specified that the capacity assessment information is kept with social worker notes, which are unavailable to the auditor. National Audit of Dementia Round 3 Luton & Dunstable Hospital 24

27 Std no N5b Discharge coordination and multidisciplinary team input 28 29a 29b 29c 29d Did a named person/ identified team coordinate the discharge plan? (y/n/na) Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the person with dementia? (y/n/na) Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the person's carer/ relative? (y/n/na) Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the consultant responsible for the patient's care? (y/n) Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with other members of the multidisciplinary team? (y/n) Has a single plan/ summary for discharge with clear updated information been produced? (y/n) Are any support needs that have been identified documented in the discharge plan/ summary? (y/n/na) Has the patient and/ or carer received a copy of the plan/ summary? (y/n/na) Was a copy of the discharge plan/ summary sent to the GP/ primary care team on the day of discharge? (y/n/na) National audit (Median, IQR) /7083 (89, 7296) /6169 (55, 3872) /6935 (82, 7191) /7329 (81, 6391) /7329 (85, 7693) /7329 (92, 7797) /6995 (61, 4479) /6975 (94, 72100) /7156 (98, 93100) / / / / / / / / / / / / / / / / /34 New question for Round 3 National Audit of Dementia Round 3 Luton & Dunstable Hospital 25

28 Std no. 5.1 Discharge planning 34 34a Was discharge planning initiated within 24 hours of admission? (y/n/na) National audit (Median, IQR) /5242 (48, 2767) 3.7 1/ /27 (If Q34=N/A) Please select the recorded reason why discharge planning could not be initiated within 24 hours: Patient acutely unwell Patient awaiting assessment Patient awaiting history/ results Patient awaiting surgery Patient presenting confusion Patient on end of life plan Patient being transferred to another Patient unresponsive Patient being discharged to nursing/ residential care / / / / / / / / / / / / /7 0 0/7 0 0/7 0 0/7 0 0/7 0 0/7 t recorded Other 0 0/ / / /7 0 0/7 0 0/ /7 0 0/7 0 0/7 0 0/7 0 0/7 0 0/7 National Audit of Dementia Round 3 Luton & Dunstable Hospital 26

29 Std no Support for carers and family National audit (Median, IQR) Carers or family have received notice of discharge and this is documented: Less than 24 hours 24 hours hours More than 48 hours notice at all t documented carer, family, friend/ could not contact Patient specified information withheld An assessment of the carer's current needs has taken place in advance of discharge: (y/n/na) / / / / / / / / /3868 (70, 5088) / / / /34 0 0/ /34 0 0/34 0 0/ / / / / /34 0 0/ /34 0 0/34 New answer option for Round /17 National Audit of Dementia Round 3 Luton & Dunstable Hospital 27

30 Appendix D: Carer demographics Age range National audit (N) (N) years 1 (48) 0 (0) years 2.9 (133) 4 (1) years 5.6 (259) 0 (0) years 16.2 (749) 12 (3) years 25.8 (1193) 40 (10) years 20.8 (960) 20 (5) years 19.1 (885) 12 (3) 85 years or over 7.4 (343) 8 (2) Prefer not to say 1.2 (56) 4 (1) Gender National audit (N) (N) Male 30.6 (1413) 19.2 (5) Female 68.1 (3150) 80.8 (21) Other 0.1 (4) 0 (0) Prefer not to say 1.2 (57) 0 (0) Ethnicity National audit (N) (N) White/ White British 88.4 (4079) 96.2 (25) Black/ Black British 3 (140) 0 (0) Asian/ Asian British 3.3 (152) 3.8 (1) Mixed 1 (44) 0 (0) Chinese 0.2 (9) 0 (0) Other 1.4 (64) 0 (0) Prefer not to say 2.7 (124) 0 (0) Relationship to patient National audit (N) (N) Spouse or partner 33.5 (1558) 34.6 (9) Family member 55.9 (2597) 61.5 (16) Friend 4.4 (203) 3.8 (1) Professional carer (health or social care) 5.4 (249) 0 (0) Other 0.9 (41) 0 (0) One of main carers for patient National audit (N) (N) 77.8 (3356) 76.9 (20) National Audit of Dementia Round 3 Luton & Dunstable Hospital 28

31 Appendix E: Carer questionnaire data Patient care Std no National audit Do you feel that staff were well informed and understood the needs of the person you look after?, definitely, to some extent / / / / / /25 Do you feel confident that staff delivered high quality care that was appropriate to the needs of the person you look after?, definitely, to some extent / / / / / /24 Was the person you look after given enough help with personal care from staff? For example, eating, drinking, washing and using the toilet., definitely, to some extent Was the person you look after treated with respect by staff?, definitely, to some extent / / / / / / / / / / /25 8 2/25 National Audit of Dementia Round 3 Luton & Dunstable Hospital 29

32 Communication Std no National audit Were you (or the patient, where appropriate) kept clearly informed about their care and progress during the stay? For example, about plans for treatment and discharge., definitely, to some extent / / / / / /26 Were you (or the patient, where appropriate) involved as much as you wanted to be in decisions about their care?, definitely, to some extent / / /4497 Did staff ask you about the needs of the person you look after to help plan their care?, definitely, to some extent / / / / / / / / /26 National Audit of Dementia Round 3 Luton & Dunstable Hospital 30

33 Overall Std no. 8 9 National audit Overall, how would you rate the care received by the person you look after during the stay? Excellent Very good Good Fair Poor / / / / / / / / / /26 How likely would you be to recommend the service to friends and family if they needed similar care or treatment? Extremely likely Likely Neither likely nor unlikely Unlikely Extremely unlikely / / / / / / / / / /26 Support for the carer Std no. 10 National audit Overall, how satisfied are you with the support you have received from this to help you in your role as a carer? Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied / / / / / / / /21 National Audit of Dementia Round 3 Luton & Dunstable Hospital 31

34 Appendix F: Staff demographics of patients encounter in role who have dementia/ possible dementia Gender National audit (N) National audit (N) (N) Up to (4559) 23.1 (18) (3651) 30.8 (24) (3489) 30.8 (24) More than (2588) 15.4 (12) (N) Male 15.7 (2260) 15.2 (12) Female 83.2 (11954) 83.5 (66) Other 0.2 (34) 0 (0) Prefer not to say 0.8 (113) 1.3 (1) Ethnicity National audit (N) (N) White/ White British 79.9 (11467) 63.3 (50) Black/ Black British 4.1 (594) 5.1 (4) Asian/ Asian British 8 (1150) 17.7 (14) Mixed 1.3 (183) 2.5 (2) Chinese 0.5 (73) 1.3 (1) Other 4.5 (646) 6.3 (5) Prefer not to say 1.7 (241) 3.8 (3) Job role National audit (N) (N) Registered nurse (Band 5 or 6) 29.9 (4300) 30.8 (24) Registered nurse (Band 7 or above) 12.7 (1831) 16.7 (13) Healthcare assistant 23.1 (3324) 25.6 (20) Doctor 11.5 (1645) 10.3 (8) Allied healthcare professional 11.9 (1713) 10.3 (8) Therapy assistant/ allied healthcare professional assistant 2.6 (367) 2.6 (2) Student 2.3 (332) 0 (0) Ward based administrators 4 (571) 2.6 (2) Other/ unknown 1.9 (279) 1.3 (1) Hours worked per week National audit (N) (N) Up to 29 hours 13 (1866) 5.1 (4) 30 hours or more 87 (12458) 94.9 (74) National Audit of Dementia Round 3 Luton & Dunstable Hospital 32

35 Time worked in the National audit (N) (N) Less than 6 months 8 (1148) 15.4 (12) 6 11 months 9.5 (1364) 7.7 (6) 1 2 years 15.6 (2242) 25.6 (20) 3 5 years 16.4 (2350) 10.3 (8) 6 10 years 15.9 (2283) 12.8 (10) years 12.1 (1739) 12.8 (10) More than 15 years 22.4 (3205) 15.4 (12) National Audit of Dementia Round 3 Luton & Dunstable Hospital 33

36 Appendix G: Staff questionnaire data Specialist services for dementia Std no Question number and text 1 1a 1b National audit National audit (, always and, most of the time responses combined) (, always and, most of the time responses combined) Do you feel supported by specialist services for dementia in your? E.g. dementia specialist team, mental health liaison, dementia champions., always, most of the time, sometimes, always, most of the time, sometimes During office hours i.e. MondayFri, 9am5pm / / / / /14024 Out of office hours / / / / / / /79 21/ / / / /64 13/ / /64 National Audit of Dementia Round 3 Luton & Dunstable Hospital 34

37 Dementia care training Std no a National audit What form did your dementia training at this take? Please tick all that apply: elearning Workshop/ study day Higher education module Workbook Other I have not received any dementia training at this / / / / / / / /67 9 6/ / / /67 Following your training at this, do you feel better prepared to provide care/ support to people with dementia?, much better prepared, somewhat better prepared / / / / /60 5 3/60 National Audit of Dementia Round 3 Luton & Dunstable Hospital 35

38 Information and communication Std no Question number and text 3 3a 4 National audit National audit (, always and, most of the time responses combined) (, always and, most of the time responses combined) In your current role, do you think that personal information is available to you to help you care for/ support people with dementia? E.g. their likes/ dislikes, preferred name, past job., always, most of the time, sometimes / / / / / / /79 36/ / /79 Do you have the opportunity to use this information to help you care for/ support people with dementia?, always, most of the time, sometimes / / / / / / /77 31/ /77 0 0/77 In your current role, do you feel encouraged to accommodate the individual needs and preferences of people with dementia? E.g. taking time to speak and interact at the pace of the person with dementia, permitting them to walk around the ward., always, most of the time, sometimes / / / / / / /78 24/ / /78 National Audit of Dementia Round 3 Luton & Dunstable Hospital 36

39 Std no National audit As a team, how often do you talk about the way you care for/ support people with complex needs (including dementia)? Frequently Occasionally Almost Never Never / / / / / / /72 0 0/72 Patient care and nutrition Std no National audit National audit (, always and, most of the time responses combined) (, always and, most of the time responses combined) Can carers of people with dementia visit at any time on the ward(s) you work on? i.e. visits are not limited to normal visiting hours and may include mealtimes., always, most of the time, sometimes / / / / / / /72 16/ / /72 Do you think that the people with dementia you care for/ support, have their nutritional needs met while on the ward(s) you work on?, always, most of the time, sometimes / / / / / / /72 44/ /72 0 0/72 National Audit of Dementia Round 3 Luton & Dunstable Hospital 37

40 Std no. 4.9 N3c [3] National audit National audit (, always and, most of the time responses combined) (, always and, most of the time responses combined) Do you think the ward(s) you work on is able to respond to the individual needs of people with dementia as they arise? E.g. pain relief, personal care, toileting, mobility assistance., always, most of the time, sometimes / / / / / / /57 39/ /57 0 0/57 Is additional staffing support provided if dependency needs on the ward(s) you work on increase?, always, most of the time, sometimes / / / / / / /57 22/ / /57 Are night time bed moves for people with dementia avoided where possible on the ward(s) you work on? By night time bed moves, we mean bed moves between the evening meal and breakfast the next morning., always, most of the time, sometimes / / / / / / /57 13/ / /57 National Audit of Dementia Round 3 Luton & Dunstable Hospital 38

41 Std no. 3.7 N3b 3.11 N3a National audit National audit (, always and, most of the time responses combined) (, always and, most of the time responses combined) In the last week (except in emergency situations), were patient mealtimes kept free of any clinical activity on the ward(s) you work on?, always, most of the time, sometimes / / / / / / /56 21/ / /56 Can you access finger food (i.e. food which can be eaten without a knife/ fork/ spoon) for people with dementia as an alternative to main meals?, always, most of the time, sometimes / / / / /8822 Can you access snacks for people with dementia in between meals?, always, most of the time, sometimes / / / / / / /57 8/ / / / /57 19/ / /57 Are the nutrition and hydration needs of people with dementia communicated at handovers/ safety briefings?, always, most of the time, sometimes / / / / / / /57 15/ /57 7 4/57 National Audit of Dementia Round 3 Luton & Dunstable Hospital 39

42 Appendix H: Staff suggestions for your The staff questionnaire included a question asking staff to make one suggestion on how their could improve care and support provided to people with dementia. Below, all suggestions from staff at Luton & Dunstable Hospital are provided. Dementia friendly sign. Flooring. Lighting. Registered Nurses (Band 5 or 6) Doing audits like this to identify the staff's difficulties and provide training to improve the staff skills. Extra training. Give every staff member in contact with patients with dementia the opportunity to attend the dementia training day. Give lots of props to the wards for a distraction box, they seem to go missing quite quickly, but work very well. Have more social areas for dementia patients to sit and eat together doing things they may find useful perhaps having familiar/ memorable music or films available. Almost like a day centre or short visit place. The only finger food we receive are sandwiches, fish fingers and sausages would be great to have ideally, fresh from the kitchen. Have more volunteers to sit with patients. Having more staff to have more time to talk and interact with patients with dementia. I don t think my could improve the care we provide for dementia patients. We already provide a high standard of care. If we had more time to spend with patients with dementia. Keep them entertained and busy! More encouragement for relatives of dementia patients to have open visiting hours. More staff trained to deal with people with dementia. Need more staff to be able to meet individualised care. Need to increase the staffing level in elderly departments where dementia patients mostly are. It will help to meet their needs properly by giving them adequate nutrition, hydration, and continence care by knowing their likes and dislikes. It will also help to reduce risks of falls which is another issue we are facing when we care for dementia patients. Providing more staff to give dementia patients the adequate care they need. Staffing numbers sometimes make it difficult to release time needed for people with dementia. To regularly have correct staff levels to provide adequate care for individuals. We could get all the patients with dementia into one room at least once a day and maybe play activities like music and games, such that they are encouraged to stay awake during the day and then help them sleep off for the night time. When they become aggressive, just need better communication with doctors and for some medication. National Audit of Dementia Round 3 Luton & Dunstable Hospital 40

43 Registered Nurses (Band 7 or above) Activities coordinator would be a great idea for the suitable patients. Dementia friendly wards for dementia patients only, where patients can be free in a safe environment and not seen as a nuisance to fellow patients, and where staff feel confident that patients will be safe e.g. able to move around ward freely with areas for different activities. For elective patients, having this information would help before patient comes into, when allocating beds. Have dementia support workers who have time to interact with the patients. Lack of staff is the main challenge when it comes to supporting dementia patients. We do not get to spend time with them. Lots of work already done at the trust, need to continue to make ward environments dementia friendly. "Day room" areas where patients can be supported by appropriately trained staff and families, with interactive activities etc. The availability of a range of snacks would help meeting nutritional needs, especially soft finger foods. We, most of the time, have support as we use the bleep system and keep in touch ASAP. I think nutritional plan should be also taken into account as dementia patients, most especially, end stage have nutritional intake issues [due to] the disease process. The family should also be informed about the disease process of patients with dementia so that they have an idea and [can] support the patient in any way. Being a dementia champion. Better staffing. Healthcare Assistants I understand the problems behind it however, I do feel the needs more staff to help out with the most confused patients. Especially on the DME (department of medicine for the elderly) ward with a bay of all confused patients. Even having one special bay, sometimes isn t enough. I feel it is still unsafe for both patient and staff. There also needs to be automatically more support on the ward when there are a high numbers of confused dementia patients who are at a high risk of falls. I think more attention and support needs to be brought to those dementia patients who refuse food/ drink etc. Also, maybe a little training for the staff to know how they deal with patients not eating/ drinking and not just letting them go without food. Making sure the "This is Me" booklet is filled in and handy for staff to read to have a better understanding of the dementia patients. More activities/ resources to occupy the time of those with dementia, e.g. more books. More funding for an increase in the dementia team, to improve knowledge to all staff re: availability of finger food or to put that in place. More staff to cope with demands of dementia patients. High calorie menu for dementia patients to be easily available rather than referral to speech and language therapist. More staff to spend [time] with dementia patients. More staffing for the patients. One to one (one member of staff to one patient), if possible. Staff who know the patient (with time) will understand the needs of that patient more, than a staff member who has been working with other patients, not necessarily that one patient. Optional mealtimes, that a patient who has missed their dinner could have a hot meal when they want and of their choosing, instead of housekeeping choosing for them. National Audit of Dementia Round 3 Luton & Dunstable Hospital 41