2010 National Audit of Dementia (Care in General Hospitals) North Middlesex University Hospital NHS Trust

Transcription

1 Royal College of Psychiatrists 2010 National Audit of Dementia (Care in General Hospitals) Organisational checklist results and commentary for: rth Middlesex University Hospital NHS Trust The 2010 national audit of dementia results for hospitals are published on myhealthlondon by permission of all NHS acute trusts in London, via the Royal College of Psychiatrists. Each trust was also invited to provide a commentary on actions taken and progress since 2010, and these are appended to the results below, where available. Organisational checklist results - first round of audit (2010) The organisational checklist looks at the service structures, policies, care processes and key staff that impact on service planning and provision for people with dementia Data was collected between March 2010 and July The national audit was repeated in 2012, with results available for participating hospitals from February The audit tools, guidance document and standards document can be downloaded from: To contact the Dementia Audit project team: Tel: / nad@cru.rcpsych.ac.uk The organisational checklist results are HQIP 2012 National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

2 National Audit of Dementia 2010: Organisational checklist rth Middlesex University Hospital NHS Trust Hospital: rth Middlesex University Hospital SECTION 1: GOVERNANCE q1 A care pathway for patients with dementia is in place In development q1a A senior clinician is responsible for implementation and/or review of the care pathway q1b Please give the job title and grade of the responsible senior clinician: Consultant Physician Care of the Elderly Dept q2 There is a named officer with designated responsibility for the protection of vulnerable adults q2a Please give the job title of the officer Director of Nursing q3a q3b q4 q5a The Executive Board regularly reviews information collected on Re-admission of patients with dementia The Executive Board regularly reviews information collected on Delayed transfers of people with dementia The Executive Board regularly reviews the number of in-hospital falls and the breakdown of the immediate causes, and patients with dementia can be identified within this number The Executive Board regularly receives feedback from The Clinical Leaders for older people and people with dementia including Modern Matrons/Nurse Consultants q5b The Executive Board regularly receives feedback on Complaints - analysed by age q5c The Executive Board regularly receives feedback from PALS - in relation to services for older people and people with dementia National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

3 q5d q6 q7 q8 9a-9c The Executive Board regularly receives feedback from Patients forums or Local Involvement Networks - in relation to services for older people and people with dementia There is a process in place to regularly review hospital discharge policy and procedures, as they relate to people with dementia Hospital: Nursing staff have access to a recognised process to record and report risks to patient care if they believe ward staffing is inadequate Audit (within the hospital) includes the percentage of people with suspected dementia for whom structural imaging, computed tomography (CT) scanning or magnetic resonance imaging (MRI) has been undertaken as part of assessment and diagnosis There is a reporting mechanism to gather information on maximum response time to obtain specialist assessment in the following situations: Access to an older people's multidisciplinary team in A&E/MAU Access to an older people's multidisciplinary team in non-elderly care wards Access to an older people's multidisciplinary team for older people with mental health problems rth Middlesex University Hospital - SECTION 2: DELIVERY OF CARE q10a1 Multidisciplinary assessment includes problem list q10a2 Multidisciplinary assessment includes co-morbid conditions q10a3 Multidisciplinary assessment includes full current medication q10a4 Multidisciplinary assessment includes nutritional status q10a5 Multidisciplinary assessment includes assessment of functioning using a standardised instrumenti.e. basic activities of daily living, instrumental activities of daily living, mobility National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

4 q10a6 q10b q10c Multidisciplinary assessment includes assessment of mental state - i.e. mental state (cognitive) testing, mood (depression) testing Hospital: Assessment includes social assessment - i.e. care input, voluntary agency support, family support, financial support Assessment includes environmental assessment - i.e. safety in the home environment, transportation needs rth Middlesex University Hospital q11 As part of initial assessment, patients are weighed on admission q12 As part of initial assessment, patients' height is measured on admission q13 Protected mealtimes are established in all wards that admit frail elderly people (75+) q14 q15 q16 q17 There are policies or guidelines in place to ensure that patients with dementia or cognitive impairment are screened for delirium, using a standardised method The care pathway for people with dementia interfaces with the palliative care pathway to ensure that people with dementia have equal access to palliative care The care pathway for people with dementia interfaces with the end of life care pathway to ensure that people with dementia have equal access to end of life care The end of life care pathway specifies that the health care team and consultant/consultant nurse discuss any issues to do with end-of-life care with the patient and carers/relatives (including resuscitation and any advance decisions made by the person with dementia) SECTION 3: MENTAL HEALTH NEEDS q18 There are systems in place to ensure that where dementia is suspected but not yet diagnosed, this triggers a referral for assessment and differential diagnosis either in the hospital or in the community (memory service) q19 An assessment of mental state is carried out on all patients over the age of 65 admitted to hospital National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

5 q20 q20a q20b q21 Hospital: There is a protocol in place governing the use of interventions for patients displaying violent or challenging behaviour, aggression and extreme agitation, which is suitable for use in patients who present behavioural and psychological symptoms of dementia (BPSD) (in line with the NICE-SCIE guideline) The protocol specifies that in care planning, restraint and sedation is used only as a final option and only if they can be justified in the best interest of the person with dementia The protocol specifies the precautions and risk assessments for any use of restraint or sedation in people with dementia and the frail elderly There is a section or prompt in the general hospital discharge summary for mental health diagnosis and management rth Middlesex University Hospital - - SECTION 4: DISCHARGE POLICY q22 The discharge policy ensures that discharge is an actively managed process which begins within 24 hours of admission q23 q24a The discharge policy specifies that information about discharge and support (written in plain English or other appropriate language) is made available to patients and their relatives on admission The discharge policy specifies that clear guidance is in use for moving or discharging a person with dementia. This specifies People with dementia should be moved only for reasons pertaining to their care and treatment q24b The move should take place during the day q24c Relatives and carers should be kept informed of any move and given adequate notice SECTION 5: INFORMATION q25 There is a formal system (pro-forma or template) in place for gathering information pertinent to caring for a person with dementia National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

6 Hospital: rth Middlesex University Hospital q26a Information collected by the pro-forma includes physical and mental health - q26b Information collected by the pro-forma includes routines and preferences - q26c Information collected by the pro-forma includes social information - q27 The form prompts staff to approach carers or relatives to collate necessary information - SECTION 6: RECOGNITION OF DEMENTIA q28 q28a q29a There is a system in place across the hospital 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 and that other staff are aware whenever the person accesses other areas, e.g. for assessment Please state what this is, e.g. visual identifier such as a symbol, marker in the case notes, etc The patient's notes are organised in such a way that it is easy to identify any communication or memory problems q29b The patient's notes are organised in such a way that it is easy to see the care plan q30 q31a q31b q31c There is a system in place to ensure that carers are advised about obtaining carer's assessment and support There are clear guidelines regarding involvement of carers and information sharing. This includes making sure the carer knows what information will be shared with them and why There are clear guidelines regarding involvement of carers and information sharing. This includes asking the carer about the extent they prefer to be involved with the care and support of the person with dementia whilst in the hospital There are clear guidelines regarding involvement of carers and information sharing. This includes asking the carer about their wishes and ability to provide care and support of the person with dementia post discharge National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

7 Hospital: rth Middlesex University Hospital SECTION 7: TRAINING, LEARNING AND DEVELOPMENT q32 Dementia awareness training relating to the care provision, systems, information and resources available in the hospital is mandatory for all acute healthcare staff involved in the care of people with dementia or who may have dementia q32a1 Dementia awareness training is mandatory for Doctors q32a2 Dementia awareness training is mandatory for Registered Nurses q32a3 Dementia awareness training is mandatory for Healthcare Assistant/Clinical Support Workers q32a4 Dementia awareness training is mandatory for Speech and Language Therapists q32a5 Dementia awareness training is mandatory for Physiotherapists q32a6 Dementia awareness training is mandatory for Rehabilitation Assistants q32a7 Dementia awareness training is mandatory for Occupational Therapists q32a8 Dementia awareness training is mandatory for other staff q32b q33 q34 q35 If other, please specify: There is a training and knowledge framework or strategy that identifies necessary skill development in working with and caring for people with dementia The training strategy specifies that staff of all grades and disciplines have access to communication skills training involving older service users The training strategy specifies that staff working with people with dementia are trained to anticipate behaviour that challenges and how to manage violence, aggression and extreme agitation, including de-escalation techniques and methods of physical restraint National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

8 Hospital: rth Middlesex University Hospital q36 All staff working with people with dementia and older adults have training in protection of vulnerable adults q37 All staff have an awareness of how to support people with hearing/visual impairments q38 q39 Clinical staff working with older people receive basic training in how to access capacity and an understanding of the Mental Capacity Act Involvement of people with dementia and carers and use of their experiences is included in the training for ward staff SECTION 8: SPECIFIC RESOURCES SUPPORTING PEOPLE WITH DEMENTIA q40 The hospital has access to intermediate care services, which will admit people with dementia q40a Access to intermediate care services allows people with dementia to be admitted to intermediate care directly and avoid unnecessary hospital admission - q41 There is a named dignity lead to provide guidance, advice and consultation to staff q42 q42a q42b q42c q43 There is a named person who takes responsibility for discharge coordination for people with dementia The person with overall responsibility for discharge coordination (as above) has training in ongoing needs of people with dementia The person with overall responsibility for discharge coordination (as above) has experience of working with people with dementia and their carers Please give the job title/grade of the person with this responsibility: There is a named person responsible for advising and supporting people with dementia and carers/relatives with: Problems getting to and from hospital; benefits; residential and nursing care; help at home; difficulties for carers/relatives such as illness, disability, stress or other commitments that may affect their ability to visit or to continue to care - - National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

9 Hospital: rth Middlesex University Hospital q43a q44 Please give the job title of the named person: There is access to specialist assessment and advice on helping patients with dementia in their swallowing and eating q44a1 Specialist assessment and advice can be obtained from Speech and Language Therapist q44a2 Specialist assessment and advice can be obtained from Dietician q44a3 Specialist assessment and advice can be obtained from Other q44b If other, please specify: Access to video fluoroscopy in Xray dept q45 q46 There is access to an interpreting service which meets the needs of people with dementia in the hospital There is access to advocacy services with experience and training in working with people with dementia SECTION 9: LIAISON PSYCHIATRY q47 The hospital provides access to a liaison psychiatry service which can provide assessment and treatment to adults throughout the hospital q47a This includes assessment and treatment of older people q47b This includes emergency/urgent assessment q47c1-c3 Please indicate the times when liaison psychiatry is available: - Day Evening National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

10 Hospital: rth Middlesex University Hospital Weekends q48 Liaison psychiatry is provided by a specialist mental health team q48a Please indicate who does provide liaison psychiatry - q49 There is a named Psychiatrist for consultation liaison q49a The Consultant Psychiatrist has dedicated time in his/her job plan to carry out consultation liaison q49b The Consultant Psychiatrist specialises in the care and treatment of older people q50a1-a6 Other members of the liaison service are: - Psychiatrist Psychologist Neuropsychologist Consultant Mental Health Nurse Mental Health Nurse Other(s) q50b If other(s), please specify: One Specialist Registrar q50c All liaison practitioners have protected time to perform consultation liaison duties q51 Liaison teams from local mental health and learning disability services offer regular training for healthcare professionals in the hospital who provide care for people with dementia National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

11 Hospital: rth Middlesex University Hospital Summary of standards met: type 1 (essential), type 2 (expected) and type 3 (aspirational) Standards Section1: Governance - type1 (total standards= 1) 1 Standards Section1: Governance - type2 (14) 2 Standards Section1: Governance - type3 (1) 0 Standards Section2: Delivery of Care - type1 (8) 8 Standards Section2: Delivery of Care - type2 (7) 7 Standards Section3: Mental Health Needs - type1 (3) 0 Standards Section3: Mental Health Needs - type2 (3) 3 Standards Section4: Discharge Policy - type2 (2) 1 Standards Section4: Discharge Policy - type3 (3) 1 Standards Section 5: Information - type1 (5) 0 Standards Section6: Recognition of Dementia - type1 (2) 1 Standards Section6: Recognition of Dementia - type2 (5) 3 Standards Section7: Training, Learning and Development - type1 (1) 0 Standards ection7: Training, Learning and Development - type2 (6) 4 Standards ection7: Training, Learning and Development - type3 (1) 0 Standards Section8: Specific Resources Supporting People with Dementia - type1 (1) 1 National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

12 Hospital: rth Middlesex University Hospital Standards Section8: Specific Resources Supporting People with Dementia - type2 (7) 0 Standards Section8: Specific Resources Supporting People with Dementia - type3 (1) 0 Standards Section9: Liaison Psychiatry - type2 (8) 8 Standards Section9: Liaison Psychiatry - type3 (1) 0 Standards All type1 standards (21) 11 Standards All type2 standards (53) 28 Standards All type3 standards (7) 1 Standards All standards (81) 40 HQIP 2012 National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

13 Appendix London Acute Trust Hospital Name(s) Trust statement on progress on dementia care since 2010 (as at July 2012). rth Middlesex University NHS Trust rth Middlesex University NHS Trust Progress against Dementia CQUIN Use of the Abbreviated Mental Test Score (AMTS) as the initial assessment in all specialties receiving adult patients. Clear guidance has been developed for triggers for more detailed assessment using the Mini Mental State Examination (MMSE). There is an alert on the Trusts Patient Administration System (PAS) identifying those patients who attend the hospital with an existing diagnosis of dementia. Teleconference involving Mental Health Services and Acute Trust to discuss patients with both existing and potential diagnosis of dementia enabling appropriate referral treatment and care. Improved data collection for readmissions and discharges. Delirium Pathway Delirium pathway in place. Training for primarily medical staff incorporated in the induction programme. Implementation of Confusion Assessment Method (CAM) to support detection of delirium, a sticker has also been developed to improve communication and alert staff to the risk of delirium. Roll out of delirium risk assessment to include preassessment clinics for surgery and any other relevant services Inpatient care Development and implementation of dementia care bundle for use on acute adult wards. This care bundle includes: Explanation of care bundle 10 Important things about me Record of behaviour that challenges (this has been modified to include potential triggers and relieving factors) National audit of dementia 2010: rth Middlesex University Hospital NHS Trust

14 Communication sheet for carers and or patients to write any concerns or questions for care staff and for care staff to provide a written response. Information on Carers Passport All documentation has now been received from the printers and this initiative will be rolled out across the Trust over the coming 6 months Training 1 day understanding Dementia workshop in partnership with Dementia UK. This is open to all staff groups 1 day Advanced Communication Skills in Dementia. In partnership with Dementia UK. This is aimed at registered staff at present and those staff who have undertaken the Understanding Dementia or similar training. Bite sized Dementia Nuggets programme Multi disciplinary and included 5 sessions. Bite sized Dementia Nuggets programme for support staff incorporating domestic, portering, hostess and security staff. Three members of the Dementia Board have attended the NHS London Train the Trainer modules to support increased in house delivery of training Requirements for Adult safeguarding, mental capacity and Deprivation of Liberty training are delivered and monitored through the Trusts mandatory training programme. Audit and Research National Audit for Dementia The Behaviour and Pain in Dementia Study (BePAID) Working towards a dementia friendly environment Both Acute Elderly Care wards have been refurbished to include different coloured bays to help way finding 40 large calendar clocks have been purchased with the support of the Hospital League of Friends to improve orientation to day, date & time The Trust has invested in two staff attending the Kings Fund Enhancing the Healing Environment Dementia Champions National audit of dementia 2010: rth Middlesex University Hospital NHS Trust