National Audit of Dementia Care in General Hospitals 2016-2017 Local report for: Good Hope Hospital Heart Of England NHS Foundation Trust July 2017 Commissioned by:
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 hospital 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). This audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP). The report is produced and published by the Royal College of Psychiatrists Centre for Quality Improvement. Healthcare Quality Improvement Partnership Ltd. (HQIP) 2017
Authors This report was prepared by Chloë Hood, Chloë Snowdon, Sarah Keane, Simone Jayakumar and Vicky Cartwright. Content is advised and approved by all members of the Steering Group. Please see full details of the Steering Group members and the Project Team below. Steering Group Professor Peter Crome, Honorary Professor, UCL, Emeritus Professor, Keele University (Chair) Professor Dawn Brooker, Director, University of Worcester Association for Dementia Dr Amanda Buttery, Innovation Fellow Dementia, South London Academic Health Science Network Angela Connelly, Carer Representative Dr Oliver Corrado, Consultant Geriatrician and Leeds Teaching Hospitals' 'Dementia Champion (NAD Clinical Lead) Dr Duncan Forsyth, Consultant Geriatrician, Cambridge University Hospitals/ British Geriatrics Society Dawne Garrett, Professional Lead for Older People and Dementia Care, Royal College of Nursing Nicci Gerrard, Carer Representative, John s Campaign Professor Rowan Harwood, Professor of Geriatric Medicine, ttingham University Hospitals Janet Husk, Programme Manager, Healthcare of Older People, Clinical Effectiveness and Evaluation Unit (CEEU), Royal College of Physicians Kelly Kaye, Partnership Manager, Dementia Action Alliance David McKinlay, Programme Manager, Healthcare Quality Improvement Partnership Dr Wendy Neil, Consultant Psychiatrist, Faculty of Old Age Psychiatry, Royal College of Psychiatrists Sean Page, Consultant Nurse Dementia, Wrexham Maelor Hospital Sue Pierlejewski, Carer Representative Dr Imran Rafi, Chair of Clinical Innovation and Research, Royal College of General Practitioners Léa Renoux, Senior Health Influencing Manager (Policy), Age UK Dr Kevin Stewart, Clinical Director, Clinical Effectiveness and Evaluation Unit (CEEU), Royal College of Physicians Beth Swanson, Lead Nurse, The James Cook University Hospital (Nurse Consultant to the audit) Gavin Terry, Policy Manager, Alzheimer's Society Dr Daphne Wallace, Living with Dementia Group Kirsten Windfuhr, Associate Director, Healthcare Quality Improvement Partnership The National Audit of Dementia Project Team Professor Mike Crawford, Director of the Royal College of Psychiatrists Centre for Quality Improvement Dr Alan Quirk, Senior Programme Manager (Research and Audit) Chloë Hood, Programme Manager Chloë Snowdon, Deputy Programme Manager Sarah Keane, Project Worker Simone Jayakumar, Project Worker Vicky Cartwright, Project Administrator Holly Robinson, Deputy Programme Manager (from 2015 to February 2016) Rahena Khatun, Project Administrator (from 2015 to June 2016) National Audit of Dementia Round 3 Good Hope Hospital 1
Acknowledgements We would like to thank all members of hospital staff and carers of people with dementia who completed a staff or carer questionnaire during this round of the audit. Thanks also to Kelly Kaye at Dementia Action Alliance, Alzheimer s Society Talking Point and Bethan Davies and Sarah Beardon of Imperial College, London. Huge thanks to staff at all of the feasibility and pilot study sites for their part in testing the tools and commenting on necessary amendments for audit proper. Special thanks to the audit leads: Louise Ayres, St Peter s Ward, Hemel Hempstead Hospital, Hertfordshire Community NHS Trust Maggie Bean, Macmillan Wolds Unit, Bridlington and District Hospital, Humber NHS Foundation Trust Wendy Blank, Dartmouth and Kingswear Community Hospital, Torbay and Devon NHS Foundation Trust Joanne Burden, Withernsea Community Hospital, Humber NHS Foundation Trust Jacqui Bussin, St Helens Hospital, St Helens and Knowsley Hospitals NHS Trust Liz Champion, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust Debra Dawson, Dawlish Community Hospital, Torbay and Devon NHS Foundation Trust Fiona Durham, Castleberg Hospital, Airedale NHS Foundation Trust Chris Dyer, Royal United Hospital Bath, Royal United Hospitals Bath NHS Foundation Trust Andrew Fletcher and Judith Gibson, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust Theresa Frang, Amersham Community Hospital, Buckinghamshire Healthcare NHS Trust Jenny Friend, Blyth Community Hospital, rthumbria Healthcare NHS Foundation Trust Lucy Frost, Zachary Merton Hospital and Uckfield Community Hospital, Sussex Community NHS Foundation Trust Carla Howgate and Sue Johnson, Southport & Formby District General Hospital, Southport and Ormskirk Hospital NHS Trust Nina Jalota and Teresa Keegal, Teddington Memorial Hospital, Hounslow and Richmond Community Healthcare NHS Trust Claire Jones, East Riding Community Hospital, Humber NHS Foundation Trust Vicki Leah, University College Hospital, University College London Hospitals NHS Foundation Trust Chooi Lee, Kingston Hospital, Kingston Hospital NHS Foundation Trust Peter McCann, Chorley and South Ribble Hospital, Lancashire Teaching Hospitals NHS Foundation Trust Anya Pinhorn, Ystradgynlais Community Hospital, Powys Teaching Health Board Evelyn Prodger, Crawley Hospital, Sussex Community NHS Foundation Trust Sharon Savigar, Liskeard Community Hospital, Cornwall Partnership NHS Foundation Trust Roger Simpson, Ilkeston Community Hospital, Derbyshire Community Health Services NHS Foundation Trust Inderpal Singh, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board Claire Smith, Lings Bar Hospital, ttinghamshire Healthcare NHS Foundation Trust Beth Swanson, South Tees Hospitals NHS Foundation Trust Andrew Thomas, Bridgnorth Community Hospital and Whitchurch Community Hospital, Shropshire Community Health NHS Trust Teresa Walls, Bluebird Lodge, Suffolk Community Healthcare, Ipswich Hospital NHS Trust Gill Withington, Warminster Hospital, Savernake Community Hospital and Chippenham Community Hospital, Wiltshire Health and Care Sue Yorwerth and Anthony White, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board Lesley Young, Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust We would also like to thank all consultants and members of the Steering Group and our Chair, Peter Crome. National Audit of Dementia Round 3 Good Hope Hospital 2
Table of Contents Introduction... 5 Mean average scores across England and Wales... 9 Good Hope Hospital scores... 10 Key findings in local and national reporting... 11 Key findings from the National Report... 11 Key findings and Good Hope Hospital... 12 Audit Themes... 22 Assessment... 23 Information and Communication... 26 Staffing and Training... 32 Nutrition... 36 Discharge... 40 Governance... 46 Staff and carer comments, carer expectations and recommendations... 54 Staff suggestions for your hospital... 55 Carer comments for your hospital... 56 Carer expectations from the National Report... 57 Full list of recommendations from the National Report... 59 List of web resources... 63 National Audit of Dementia Round 3 Good Hope Hospital 3
List of Figures and Tables Figures Figure 1: Percentage of patients who had an initial screening for delirium, a clinical assessment for delirium folowing the screening and symptoms of delirium summarised for discharge... 12 Figure 2: Results from the mini audit, showing the percentage of patients checked who had a personal information document present... 13 Figure 3: Percentage of casenotes where information about the person with dementia had been collected.. 14 Figure 4: Carers perspective on how well informed staff were about the needs of the person with dementia 15 Figure 5: Staff perspective on the availability of personal information to help them care for/ support people with dementia... 15 Figure 6: Staff perspective on meeting the nutritional needs of patients with dementia... 16 Figure 7: Staff perspective on access to finger foods for people with dementia... 17 Figure 8: Staff perspective on access to snacks for people with dementia... 17 Figure 9: Staff view of training provided by their current hospital... 18 Figure 10: Staff perspective on support available from specialist dementia services during office hours... 19 Figure 11: Staff perspective on support available from specialist dementia services out of hours... 19 Figure 12: Carer perspective on whether the person with dementia was treated with respect... 20 Figure 13: Carer view of support provided to them by the hospital... 21 Figure 14: Carer overall view of patient care provided by the hospital... 21 Tables Table 1: Explanation of how data tables are presented in audit theme chapters... 8 Table 2: Range of scores in the national sample, broken down by quartile... 10 Table 3: s scores and rankings... 10 Table 4: Assessment score for your hospital... 23 Table 5: Information and communication scores for your hospital... 26 Table 6: Nutrition score for your hospital... 36 Table 7: Discharge score for your hospital... 40 Table 8: Governance score for your hospital... 46 National Audit of Dementia Round 3 Good Hope Hospital 4
Introduction Local reporting This local report contains a full presentation of your results for the third round of the National Audit of Dementia alongside the national results from all participating hospitals. If your hospital participated in the second round, these results are also shown where applicable. The national data and data from your hospital are presented in four ways in this report: Themed scores derived from the four audit tools Key messages and recommendations from this round s National Report A full breakdown of your data by audit theme A full breakdown of your data by audit tool (in separate Appendices document). Background to the audit The National Audit of Dementia (care in general hospitals) examines aspects of care received by people with dementia in general hospitals in England and Wales. The audit is commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England and the Welsh Government, as part of the National Clinical Audit Programme. The audit is managed by the Royal College of Psychiatrists in partnership with: Royal College of Nursing Royal College of Physicians British Geriatrics Society Alzheimer s Society Dementia Action Alliance Age UK John s Campaign. Data collection There have been two previous rounds of the National Audit of Dementia, reporting in 2011 and 2013. Round 2 of the audit showed that while significant progress in the care provided to people with dementia had taken place, some aspects of care still needed to evolve. The Round 2 report recommended collecting feedback from the carers of people with dementia and staff who provide care, to gain a better understanding of important aspects of care, such as communication and understanding individual needs. Round 3 of the National Audit of Dementia collected data between April and vember 2016. The audit was open to all general acute hospitals in England and Wales providing acute services on more than one ward which admit adults over the age of 65. One hundred and ninety-nine hospitals in England and Wales (98 of eligible hospitals) took part in this round of audit. A list of participating hospitals is on our website. National Audit of Dementia Round 3 Good Hope Hospital 5
Participating hospitals were asked to complete four elements for the audit: A hospital level organisational checklist A retrospective casenote audit with a target of a minimum of 50 sets of patient notes A survey of carer experience of quality of care A staff questionnaire on providing care and support to people with dementia. In total, the audit received 199 organisational checklists, 10047 casenote submissions, 14416 staff questionnaires and 4664 carer questionnaires. Hospitals which submitted less than 5 carer or staff questionnaires, have not received any data in their local report in order to protect anonymity. Hospitals which submitted 5 to 9 of either questionnaire have not received the demographic information for that questionnaire. Good Hope Hospital completed an organisational checklist, submitted 55 casenote audits, submitted 54 eligible staff questionnaires and 55 eligible carer questionnaires. Audit standards The standards for the National Audit of Dementia have been derived from national and professional guidance, including NICE Quality Standards, the Dementia Friendly Hospitals Charter and reports from the Alzheimer s Society, Age Concern and Royal Colleges. The standards have been compiled with their sources and the questions used to measure them, and can be found on the audit website. How to use this report Scoring in Round 3 of audit For the first time for the National Audit of Dementia, we present hospital level scores. The scoring system allows easy comparison between hospitals on the different themes of the audit. There are seven scores, each relating to an audit theme, plus a score for the carer overall rating of care. There was insufficient data available to produce a score for the staffing and training theme. The full method for the scoring can be found on the audit website. On pages 9 and 10 you will find the national mean averages, the scores for your hospital and the range of scores for each theme. To receive a full set of scores, hospitals were required to provide one complete organisational checklist, more than 19 casenotes, 20 or more eligible staff questionnaires and 10 or more carer questionnaires. Hospitals with fewer than the required number, have not received a score for that theme. Scores are derived from separate data sources and therefore should be viewed independently. For example, a hospital s score for Assessment should only be compared to other Assessment scores, rather than the other scores for the same hospital. A hospital s highest score may not reflect its area of greatest achievement, if it is a theme in which all hospitals have scored highly. National Audit of Dementia Round 3 Good Hope Hospital 6
Case adjustment The impact of gender, age and ethnicity on scores were examined. The differences between the unadjusted and adjusted hospital scores were very small and there were no meaningful adjustments to be made. Therefore, all scores have been left in an unadjusted format. Data breakdown by audit theme Audit standards are measured across the audit tools. Therefore, data submitted are presented thematically, with data from different tools presented together. The themes are: 1. Assessment Data from the casenote audit. This looks at whether people with dementia admitted to hospital have received a comprehensive assessment, and how well each element of assessment is carried out. 2. Information and communication Data from the organisational checklist, casenote audit, staff and carer questionnaires. This looks at communication systems in use in the hospital, evidence of their use in casenotes and presents feedback from carers and staff about the quality of communication. 3. Staffing and training Data from the organisational checklist, staff questionnaire and carer questionnaire. This looks at staffing provision, the extent of training delivery in hospitals and presents feedback from staff on training quality. 4. Nutrition Data from the organisational checklist and staff questionnaire. This looks at whether hospitals have services that provide for the needs of people with dementia and presents feedback from staff on service quality. 5. Discharge and hospital transfer Data from the organisational checklist and casenote audit. This looks at the extent of planning for discharge from hospital for people with dementia and whether they and their carers are adequately informed. 6. Governance Data from the organisational checklist, staff questionnaire and carer questionnaire. This looks at the involvement of hospital leads and the Executive Board in leading, planning and monitoring care, review of the environment and carer engagement. National Audit of Dementia Round 3 Good Hope Hospital 7
Data tables in audit theme chapters Table 1: Explanation of how data tables are presented in audit theme chapters Std Question number, tool and text Standard reference and type. Standards document can be found on the audit website. Audit tool that item appears in and question number. Question wording as in tool. The national audit refers to all hospitals from England and Wales that participated in Round 3 of the audit. Data for your hospital from Round 3. If the same question or a similar question was asked in Round 2, we have provided your Round 2 data, for comparison. Therefore, the carer and staff questionnaires are not represented in this column. We have provided the percentage yes response (unless otherwise indicated) and the numerator/ denominator. The denominator will change throughout the report, depending on whether questions were routed (not asked in some instances), N/A responses chosen (these have been excluded from the analyses), or if staff and carers did not respond to a question. 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. Comparison of the data should be made with caution. Quality Assurance visits Quality assurance visits were carried out to five randomly selected sites, and items checked across ten casenotes submitted, also randomly selected. It appears that there may be some variation in the ways in which sites are carrying out and recording some assessments and discharge planning. This may also affect your results. adjustments were made to data following the quality assurance visits. Data breakdown by audit tool Data has also been presented by audit tool. This can be found in the separate Appendices document. Inter-rater reliability Inter-rater reliability analysis was carried out for the casenote audit and full results are on the audit website. Any items with an inter-rater agreement of less than 0.5 have been highlighted in the casenote audit, Appendix C (Appendices in a separate document). National Audit of Dementia Round 3 Good Hope Hospital 8
Mean average scores across England and Wales The scores presented below are the national mean averages from the 7 scoring themes, based on data submitted by 199 hospitals in England and Wales. A table with scores for each of the participating hospitals can be found in the National Report on the audit website. National Audit of Dementia Round 3 Good Hope Hospital 9
Good Hope Hospital scores Below are the scores derived from the data submitted by your hospital and your hospital ranking for each score. Some hospitals have not received a full set of scores if they submitted insufficient amounts of data. The scores are derived from separate data sources and should be viewed independently. For more information, please see page 6. Table 2: Range of scores in the national sample, broken down by quartile Score Highest scores - - - - - - - - - - - - - - - - - - - - - - - Lowest Scores Governance 100-84.4 81.3-65.6 62.5-50 48.4-12.5 Nutrition 100 95-87.5 82.5-73.8 68.8-36.3 Discharge 98.5-85.2 84.6-75.3 75.2-63.6 63.2-22 Assessment 99.1-88.9 88.6-85.4 85.2-79.9 79.7-48.7 Staff rating of information & communication Carer rating of information & communication 82.7-68.5 68.4-64.8 64.7-61.6 61.5-48.1 89.3-71.7 71.5-63.4 63.1-57.3 57.2-22.2 Carer rating of patient care 93.3-77.9 77.8-72.4 72.3-66.1 64.7-21.7 Table 3: s scores and rankings Scoring score rank (out of) Governance 43.8 165 (199) Nutrition 100 1 (199) Discharge 82 58 (195) Assessment 86 84 (195) Staff rating of information & communication Carer rating of information & communication 66.4 73 (182) 64.2 55 (148) Carer rating of patient care 75.9 55 (148) National Audit of Dementia Round 3 Good Hope Hospital 10
Key findings in local and national reporting The National Report for this round of audit contained five key messages derived from the national data set. These are shown below. For local reporting, we have included graphical representations of data related to the key findings to allow for comparison between your hospital and the national results. These can be found starting on page 12. Key findings from the National Report Delirium recording requires improvement In more than half of casenotes of people with dementia, there was no recording of an initial screen or check for symptoms of delirium. Inconsistency in what is recorded and communicated may affect clinical care and thereby increase a person with dementia s risk to developing delirium. Personal information to support better care must be accessible A ward spot check carried out during the audit looked for the document with key personal information about care needs and communication that should be completed for people with dementia, and found that only half of these patients had one in place. Forty percent of staff said that they could not access this information most of the time, and under half of carers said definitely, staff were well informed. Services must meet the nutritional needs of people with dementia Catering services should be able to provide for the needs of people with dementia, who may not be able to eat full meals at regular times and need finger food meal alternatives and snacks available at any time to ensure they are nourished. Less than 75 of staff said that they could obtain finger foods or snacks between meals for these patients. Twenty-four percent of staff thought people with dementia had nutritional needs met sometimes, or were not met. Championing dementia means supporting staff To support staff to deliver better care, nearly all hospitals have created dementia champions at ward level. Just under 70 of carers gave a high rating to care overall. Staff said they needed more support, especially out of hours when less than a quarter of staff said they could access specialist support for dementia always or most of the time. Involve the person with dementia in decision making Where a change in residence after discharge (e.g. from their own home to a care home) was proposed, just over one third of patients did not have their consent to begin this process recorded, or evidence that a best interests decision making process had taken place, in the case that they lacked capacity. National Audit of Dementia Round 3 Good Hope Hospital 11
Key findings and Good Hope Hospital This section of the report presents some of the data and recommendations associated with the key findings. Some additional questions from the carer questionnaire are also included. Each figure shows the national mean average results next to the data for your hospital to allow for easy comparison. All percentages have been rounded up to a whole number which means some results may calculate to just under or over 100. The national averages include data collected from 199 hospitals across England and Wales. The exact sample sizes for both the national sample and the sample for your hospital are presented in the figure titles. Very low sample sizes (below ten) should be interpreted with caution. Sample sizes of four or less are indicated in the title but are not shown on the graph (the bar for your hospital will be blank and you will see a symbol ( ) to indicate this) as they cannot be interpreted with reliability. Delirium Figure 1 shows the percentage of patients receiving an initial and full clinical assessment for delirium, alongside the percentage of patients who had symptoms of delirium summarised (where applicable) for discharge. All of this data is taken from the casenote audit. Please note that initial delirium assessment is an item with lower than average inter-rater reliability (full results can be found on the audit website). Therefore, your results may relate to inconsistency in the recording of this assessment which may point to a need to agree local procedures to ensure that this important information is consistently recorded and shared. 100 100 90 85 88 80 70 of casenotes 60 50 40 30 45 27 48 20 10 0 Initial screening for delirium Clinical assessment for delirium Type of delirium assessment National average Symptoms of delirium summarised for discharge Figure 1: Percentage of patients who had: an initial screening for delirium, for the national sample (n=10047) and your hospital (n=55); a clinical assessment for delirium following the screening, for the national sample (n=2603) and your hospital (n=11); symptoms of delirium summarised for discharge, for the national sample (n=2367) and your hospital (n=8). National Audit of Dementia Round 3 Good Hope Hospital 12
Key recommendations: 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 patients 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 about the person with dementia Information about the collection and use of personal information for people with dementia was collected via the organisational checklist, casenote audit, staff questionnaire and carer questionnaire. Although some items on the organisational checklist suggested that the use of personal information collection tools was at close to 100, items from the other audit tools suggest that in practice, this figure is lower. Figures 2 to 5 show data about personal information collection in practice. Hospitals were asked to complete a mini spot check of whether patients who should have a personal information document in their notes had one. Figure 2 shows the results of this mini audit. 100 of patients with a personal information document 90 80 70 60 50 40 30 20 10 49 30 0 National average Figure 2: Results from the mini audit, showing the percentage of patients checked who had a personal information document present. National sample (median number checked=10) and your hospital sample (n=10). National Audit of Dementia Round 3 Good Hope Hospital 13
Figure 3 shows that some pieces of personal information are more often found in patient notes than others. At a national level, the pieces of information recorded least often are factors which may cause distress and actions which can help to calm the patient. An unknown response was provided for these questions in Round 3 for hospitals to indicate where this information is usually recorded in a document which accompanies the patient (e.g. This is Me or patient passport) and no copy was available in the notes. of casenotes 100 90 80 70 60 50 40 30 20 10 15 20 22 29 33 75 75 75 75 75 30 33 34 38 39 55 47 44 33 28 22 86 35 43 0 Personal detailsfood and drink and preferences preferences National average ( responses) National average ( responses) Support with personal care Factors may cause distress Actions which can calm patient Information in the casenotes about the person with dementia Details to aid communication National average (Unknown responses) ( responses) Figure 3: Percentage of casenotes where information about the person with dementia had been collected. National sample and your hospital sample (see Appendix C for sample sizes). The carer questionnaire asked carers how well informed they thought staff were about the needs of the person with dementia. The results are shown in Figure 4. National Audit of Dementia Round 3 Good Hope Hospital 14
100 90 80 10 6 of carers 70 60 50 40 30 20 10 0 43 48 47 46 National average Do you feel that hospital staff were well informed and understood the needs of the person you look after?, definitely, to some extent Figure 4: Carers perspective on how well informed staff were about the needs of the person with dementia. National sample (n=4578) and your hospital sample (n=54). The staff questionnaire also assessed availability of personal information for people with dementia by asking staff whether this information was accessible to them. The results of this are shown in Figure 5. 100 90 7 4 80 70 33 34 60 of staff 50 40 30 39 34 20 10 21 28 0 National average In your current role, do you think that personal information is available to you to help you care for/ support people with dementia?, always, most of the time, sometimes Figure 5: Staff perspective on the availability of personal information to help them care for/support people with dementia. National sample (n=14345) and your hospital sample (n=53). National Audit of Dementia Round 3 Good Hope Hospital 15
Key recommendations: Personal information 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. Nutritional needs of people with dementia The staff questionnaire collected data on aspects of patient nutrition and hydration. Figures 6, 7 and 8 show staff responses to three of these questions. Figure 6 shows that nationally, almost a quarter of staff thought that the nutritional needs of people with dementia were not met at least most of the time. 100 90 80 5 5 19 14 of staff 70 60 50 40 30 20 10 50 26 41 41 0 National average Do you think that 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 Figure 6: Staff perspective on meeting the nutritional needs of patients with dementia. National sample (n=12263) and your hospital sample (n=42). The staff questionnaire asked nurses and healthcare assistants working on wards at mealtimes about accessing finger foods and snacks between meals for people with dementia. The results are presented in Figures 7 and 8. National Audit of Dementia Round 3 Good Hope Hospital 16
100 90 12 15 80 70 60 23 33 of staff 50 40 27 9 30 20 38 42 10 0 National average Can you access finger food for people with dementia as an alternative to main meals?, always, most of the time, sometimes Figure 7: Staff perspective on access to finger foods for people with dementia. National sample (n=8822) and your hospital sample (n=33). 100 90 80 70 6 21 12 18 of staff 60 50 40 30 20 10 0 29 21 45 49 National average Can you access snacks for people with dementia in between meals?, always, most of the time, sometimes Figure 8: Staff perspective on access to snacks for people with dementia. National sample (n=9119) and your hospital sample (n=33). National Audit of Dementia Round 3 Good Hope Hospital 17
Key recommendations: 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). Support for staff The staff questionnaire asked staff about various aspects of support provided to them when caring for or supporting people with dementia. Figures 9, 10 and 11 demonstrate how staff rated some of these aspects of support. Figure 9 shows how prepared staff felt after completing one or more forms of training provided by the hospital they currently work in. Responses where the respondent indicated they were answering about training received elsewhere were not included in analyses. of staff 100 90 80 70 60 50 40 30 20 10 0 7 51 0 57 42 43 National average Following your training at this hospital, do you feel better prepared to provide care/ support to people with dementia?, much better prepared, somewhat better prepared Figure 9: Staff view of training provided by their current hospital. National sample (n=10670) and your hospital sample (n=37). The staff questionnaire also asked staff how well supported they felt by the specialist services for dementia in their hospital. It is notable that the national view of the availability of support services out of hours is rated much more negatively (Figure 11) than support during office hours (Figure 10). Hospitals may wish to consider how they can improve the availability of this specialist support for staff during the night and at weekends. National Audit of Dementia Round 3 Good Hope Hospital 18
of staff 100 90 80 70 60 50 40 30 20 10 0 12 13 27 39 33 20 29 28 National average Do you feel supported by specialist services for dementia in your hospital during office hours?, always, most of the time, sometimes Figure 10: Staff perspective on support available from specialist dementia services during office hours. National sample (n=14024) and your hospital sample (n=54). 100 90 of staff 80 70 60 50 40 30 20 10 0 49 47 28 30 16 12 8 12 National average Do you feel supported by specialist services for dementia in your hospital out of office hours?, always, most of the time, sometimes Figure 11: Staff perspective on support available from specialist dementia services out of hours. National sample (n=11207) and your hospital sample (n=43). Key recommendation: support for staff 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. National Audit of Dementia Round 3 Good Hope Hospital 19
Involving the person with dementia in decision making National data from England and Wales showed that in 34 of cases where a referral to a social worker was made for a proposed change in residence post discharge, consent from the person with dementia (or a best interests decision making process when the person did not have capacity to make this decision) is not recorded in the notes. To compare this national data with data from your hospital, please go to the discharge theme chapter (casenote audit, question 27). Key recommendation: 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. The opinion of carers One of the key aims for this round of audit was to collect feedback from carers which could be compared across hospitals, and to ask them to rate the care that was received by the person they care for, while in hospital. Hospitals report taking steps to involve carers, including development of strategies for engaging carers and adopting the aims of John s Campaign (allowing a family carer to remain with a person with dementia and support them during admission). The carer questionnaire aimed to see whether carers themselves reported the same. Below are some key points from the carer questionnaire. Please also see your scores for overall carer rating of patient care, and carer rating of information and communication on page 10. At a national level, the most positively answered question on the carer questionnaire asked carers whether the person they look after was treated with respect. 100 90 80 3 4 21 19 of carers 70 60 50 40 30 20 10 0 76 78 National average Was the person you look after treated with respect by hospital staff?, definitely, to some extent Figure 12: Carer perspective on whether the person with dementia was treated with respect. National sample (n=4569) and your hospital sample (n=54). National Audit of Dementia Round 3 Good Hope Hospital 20
Figure 13 shows data from the only question on the carer questionnaire which asked carers how well supported they themselves felt by the hospital while the person they care for was admitted. of carers 100 90 80 70 60 50 40 30 20 10 0 6 6 10 8 34 38 50 48 National average Overall, how satisfied are you with the support you have received from this hospital to help you in your role as a carer? Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied Figure 13: Carer view of support provided to them by the hospital. National sample (n=4379) and your hospital sample (n=50). The carer questionnaire also asked carers for their overall opinion of the care provided to the person they care for while in hospital. This question makes up the score for carer rating of patient care. of carers 100 90 80 70 60 50 40 30 20 10 0 5 2 10 9 17 34 35 16 29 44 National average Overall, how would you rate the care received by the person you look after during the hospital stay? Excellent Very good Good Fair Poor Figure 14: Carer overall view of patient care provided by the hospital. National sample (n=4645) and your hospital sample (n=55). National Audit of Dementia Round 3 Good Hope Hospital 21
Audit themes Assessment Information and communication Staffing and training Nutrition Discharge and hospital transfer Governance National Audit of Dementia Round 3 Good Hope Hospital 22
Assessment Items presented in this theme are from the casenote audit and refer to assessments done upon or during admission. Assessments completed for discharge can be found in the discharge theme chapter. Presentation of items and scoring For information on how the data tables in the chapters are laid out, please see page 8. The assessment theme has an associated score. The score for your hospital and the national mean average are shown in table 4. For further information on scoring, please see page 6. Table 4: Assessment score for your hospital Assessment score () Good Hope Hospital 86 National average 83.7 National Audit of Dementia Round 3 Good Hope Hospital 23
I. Multi-disciplinary assessment Std 1.9 [1] 1.10 [1] 1.12 [1] 1.11 [1] 1.13 [1] 14 15 15a 16 17 18 19 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) 93.8 8558/9126 89.8 8832/9837 90.4 47/52 98.1 53/54 96.9 31/32 97.5 39/40 (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 85.9 7580/8822 98.1 52/53 88.2 30/34 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) Has an assessment of functioning been carried out?, a standardised assessment has taken place, an occupational therapy and/or a physiotherapy assessment has taken place, other (all options) 4 352/8822 95.5 9590/10044 88 8572/9744 83.2 8185/9840 45.3 4212/9294 42.8 3977/9294 1.7 161/9294 89.8 8350/9294 1.9 1/53 98.2 54/55 96.4 53/55 100 55/55 40.7 22/54 48.1 26/54 1.9 1/54 90.7 49/54 New answer option for Round 3 100 40/40 92.5 37/40 94.9 37/39 11.4 4/35 New answer options for Round 3 National Audit of Dementia Round 3 Good Hope Hospital 24
II. Mental state assessment Std 1.3 [2] 1.4 [2] 1.5 [2] 20 21 21a Has a standardised mental status test been 54 57.7 56.3 carried out? (y/n/could not be assessed for 4684/8682 30/52 18/32 recorded reasons) 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 25.9 20 7.5 may be present 2603/10047 11/55 3/40, but there was no indication that delirium 18.5 7.3 2.5 may be present 1863/10047 4/55 1/40 (both options) (If Q21=) Has the patient been clinically assessed for delirium by a healthcare professional? (y/n) 44.5 4466/10047 85.3 2220/2603 27.3 15/55 100 11/11 10 4/40 0 0/3 National Audit of Dementia Round 3 Good Hope Hospital 25
Information and Communication Items presented in this theme are from the organisational checklist, casenote audit, staff questionnaire and carer questionnaire. The questions relate to personal information collected about people with dementia, communication between staff members and communication between staff and carers. Presentation of items and scoring For information on how the data tables in the chapters are laid out, please see page 8. The information and communication theme has two associated scores. One score for carer rating of information and communication and one for staff rating of information and communication. The scores for your hospital and the national mean averages are shown in table 5. For further information on scoring, please see page 6. Table 5: Information and communication scores for your hospital Carer rating () Staff rating () Good Hope Hospital 64.2 66.4 National average 64.4 64.8 National Audit of Dementia Round 3 Good Hope Hospital 26
I. Information about the patient with dementia a. Data from the organisational checklist and casenote audit Std 1.14 [1] 16 22 17a 22a 17b 22c 17c 22d 17d There is a formal system (pro-forma or template) in place in the hospital for gathering information pertinent to caring for a person with dementia: (y/n) 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) (If Q16=) Information collected by the proforma includes personal details, preferences and routines: (y/n) 98.5 196/199 57.2 5727/10010 100 196/196 16.4 9/55 7.5 3/40 (If Q22=) Has information been collected about the patient regarding personal details, preferences and routines? 47.4 75 100 2669/5626 6/8 3/3 Unknown* (If Q16=) Information collected by the proforma includes reminders or support with personal care: (y/n) 33.1 1865/5626 98.5 193/196 12.5 1/8 N/A New answer option for Round 3 (If Q22=) Has information been collected about the patient regarding reminders or support with personal care? 55.3 75 100 3116/5631 6/8 3/3 New answer 29.9 12.5 Unknown* option for 1685/5631 1/8 Round 3 (If Q16=) Information collected by the proforma includes recurring factors that may cause or exacerbate distress: (y/n) 100 196/196 (If Q22=) Has information been collected about the patient regarding recurring factors that may cause or exacerbate distress? 32.6 75 66.7 1818/5583 6/8 2/3 New answer 37.8 12.5 Unknown* option for 2110/5583 1/8 Round 3 (If Q16=) Information collected by the proforma includes support or actions that can calm the person if they are agitated: (y/n) 99 194/196 N/A N/A N/A National Audit of Dementia Round 3 Good Hope Hospital 27
Std 1.15 [3] 1.14 [1] 22e 18 17e 22f 22b 19 20 (If Q22=) Has information been collected about the patient regarding support or actions that can calm the person if they are agitated? 28.2 75 50 1564/5539 6/8 1/2 New answer 39.1 12.5 Unknown* option for 2167/5539 1/8 Round 3 (If Q16=) Information collected by the proforma includes how the person with dementia communicates with others/ understands communication: (y/n) (If Q16=) Information collected by the proforma includes life details which aid communication: (y/n) 99.5 195/196 99.5 195/196 New question for Round 3 (If Q22=) Has information been collected about the patient regarding life details which aid communication? 43.1 85.7 66.7 2413/5598 6/7 2/3 Unknown* 35.3 1977/5598 0 0/7 N/A New answer option for Round 3 (If Q22=) Has information been collected about the patient's food and drink preferences? 44.1 75 2476/5616 6/8 New question Unknown* 34.1 12.5 for Round 3 1916/5616 1/8 (If Q16=) The form prompts staff to approach carers or relatives to collate necessary information: (y/n) 93.4 183/196 Documenting use of personal information in practice: Hospitals selected three adult inpatient wards which had the highest admissions of people with dementia. Ten 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 Number of patients checked: - 10 Range 0-40 - Median 10 - Number of these patients where the information was present: - 3 Percentage of patients where the information was present: - 30 Range 0-100 - Mean 49 - Median 50 - *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. N/A New question for Round 3 New question for Round 3 National Audit of Dementia Round 3 Good Hope Hospital 28
Std 1.14 [1] 9.3 [1] 7.4 [2] 7 CQ 1 CQ 3 SQ 3a SQ 4 SQ b. Data from the carer and staff questionnaires Did hospital staff ask you about the needs of the person you look after to help plan their care?, definitely 45.4 48.1 2053/4524 26/54, to some extent 34.5 31.5 New tool for 1563/4524 17/54 Round 3 20.1 20.4 908/4524 11/54 Do you feel that hospital staff were well informed and understood the needs of the person you look after?, definitely 46.5 46.3 2130/4578 25/54, to some extent 43.3 48.1 New tool for 1980/4578 26/54 Round 3 10.2 5.6 468/4578 3/54 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 21.4 28.3 3072/14345 15/53, most of the time 38.5 34 5525/14345 18/53 New tool for, sometimes 33 34 Round 3 4734/14345 18/53 7.1 3.8 1014/14345 2/53 Do you have the opportunity to use this information to help you care for/ support people with dementia?, always 26.6 30.8 3549/13329 16/52, most of the time 40.9 32.7 5454/13329 17/52 New tool for, sometimes 30.6 30.8 Round 3 4074/13329 16/52 1.9 5.8 252/13329 3/52 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 28.9 33.3 4145/14333 18/54, most of the time 33.2 29.6 4759/14333 16/54 New tool for, sometimes 27.3 29.6 Round 3 3913/14333 16/54 10.6 7.4 1516/14333 4/54 National Audit of Dementia Round 3 Good Hope Hospital 29
Std 2 CQ 4 CQ Do you feel confident that hospital staff delivered high quality care that was appropriate to the needs of the person you look after?, definitely 54.2 56.4 2489/4592 31/55, to some extent 36.4 34.5 New tool for 1672/4592 19/55 Round 3 9.4 9.1 431/4592 5/55 Was the person you look after treated with respect by hospital staff?, definitely 76 77.8 3471/4569 42/54, to some extent 20.8 18.5 New tool for 952/4569 10/54 Round 3 3.2 3.7 146/4569 2/54 II. Communication between staff Std 9.3 [1] 21 21a 22 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: (y/n) (If Q21=) Please say what this is: A visual indicator, symbol or marker Alert sheet or electronic flag (updated option for Round 3) A box to highlight or alert dementia condition in the notes or care plan Other There is a system in place across the hospital 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) 90.5 180/199 91.1 164/180 23.9 43/180 33.9 61/180 18.9 34/180 70.4 140/199 N/A N/A N/A N/A N/A National Audit of Dementia Round 3 Good Hope Hospital 30
Std 9.3 [1] 7.12 [1] 22a 6 SQ (If Q22=) Please say what this is: A visual indicator, symbol or marker 87.1 122/140 N/A Alert sheet or electronic flag (Updated option 18.6 for Round 3) 26/140 N/A A box to highlight or alert dementia condition 20.7 in the notes or care plan 29/140 N/A N/A Other 17.9 N/A 25/140 As a team, how often do you talk about the way you care for/ support people with complex needs (including dementia)? Frequently 49.8 47.6 6203/12457 20/42 Occasionally 37.2 38.1 4636/12457 16/42 New tool for Almost Never 9.7 9.5 Round 3 1210/12457 4/42 Never 3.3 4.8 408/12457 2/42 III. Involvement of carers and people with dementia Std 9.7 [2] 9.11 [2] 9.13 [2] 5 CQ 6 CQ 23 Were you (or the patient, where appropriate) kept clearly informed about their care and progress during the hospital stay? For example, about plans for treatment and discharge. 41.8 38.9, definitely 1908/4566 21/54 40.4 48.1 New tool for, to some extent 1843/4566 26/54 Round 3 17.8 13 815/4566 7/54 Were you (or the patient, where appropriate) involved as much as you wanted to be in decisions about their care? 47.5 48, definitely 2138/4497 24/50 36.4 36 New tool for, to some extent 1637/4497 18/50 Round 3 16.1 16 722/4497 8/50 The dementia lead or dementia working group collates feedback from carers on the written and verbal information provided to them: (y/n) 81.9 163/199 New question for Round 3 National Audit of Dementia Round 3 Good Hope Hospital 31
Staffing and Training Items presented in this theme are from the organisational checklist, staff questionnaire and carer questionnaire. Questions relate to hospital staffing levels and the training available to staff on dementia care. Presentation of items and scoring For information on how the data tables in the chapters are laid out, please see page 8. The staffing and training theme has no associated score. This is because there was insufficient data nationally for this theme. For further information on scoring, please see page 6. National Audit of Dementia Round 3 Good Hope Hospital 32
I. Staffing levels Std N7a [3] 4.9 [2] 1.14 [1] 10 11 9 SQ 10 SQ 3 CQ Ward staffing levels (nurses, midwives and care staff) are made available for the public to view on a monthly basis: (y/n) An evidence-based tool is used for establishing ward staffing levels: (y/n) 88.4 176/199 New question for Round 3 99 New question 197/199 for Round 3 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 30.4 40.6 2785/9148 13/32, most of the time 47.6 37.5 4352/9148 12/32 New tool for, sometimes 18.7 21.9 Round 3 1708/9148 7/32 3.3 0 303/9148 0/32 Is additional staffing support provided if dependency needs on the ward(s) you work on increase?, always 10.7 9.4 977/9143 3/32, most of the time 27.5 34.4 2516/9143 11/32 New tool for, sometimes 42.5 34.4 Round 3 3887/9143 11/32 19.3 21.9 1763/9143 7/32 Was the person you look after given enough help with personal care from hospital staff? For example, eating, drinking, washing and using the toilet., definitely 55.4 49 2456/4433 24/49, to some extent 34.2 44.9 New tool for 1515/4433 22/49 Round 3 10.4 6.1 462/4433 3/49 II. Guidance for staff Std 7.1 [2] 31 There is a named dignity lead to provide guidance, advice and consultation to staff: (y/n) 70.4 140/199 National Audit of Dementia Round 3 Good Hope Hospital 33
III. Training and knowledge framework Std 7.2 [2] 7.11 [3] 24 26 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) Involvement of people with dementia and carers and use of their experiences is included in the training for ward staff: (y/n) 95.5 190/199 82.4 164/199 IV. Dementia care training Std 7.5 [3] 7.4 [2] 27 2 SQ 2a SQ What format is used to deliver basic dementia awareness training? elearning module 72.9 145/199 Workshop or study day 91 181/199 Higher education module 22.6 45/199 Other 29.1 58/199 - - New question for Round 3 What form did your dementia training at this hospital take? Please tick all that apply: elearning module 42.8 48.9 5653/13205 22/45 Workshop or study day 53.2 62.2 7030/13205 28/45 Higher education module 5.4 2.2 New tool for 713/13205 1/45 Round 3 Workbook 7.7 11.1 1018/13205 5/45 Other 7.3 6.7 961/13205 3/45 I have not received any dementia training at this hospital 17.3 2278/13205 15.6 7/45 Following your training at this hospital, do you feel better prepared to provide care/ support to people with dementia?, much better prepared 42.2 43.2 4502/10670 16/37, somewhat better prepared 50.5 56.8 New tool for 5390/10670 21/37 Round 3 7.3 0 778/10670 0/37 National Audit of Dementia Round 3 Good Hope Hospital 34
Std 25 The question below is 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 is: Doctors Mandatory 46.2 92/199 - - Provided on induction 63.3 126/199 - Provided in the last 12 months 58.8 117/199 - - t provided in the last 12 months 8.5 17/199 - Nurses Mandatory 51.8 103/199 - - Provided on induction 74.4 148/199 - Provided in the last 12 months 68.3 136/199 - - t provided in the last 12 months 1 2/199 - Healthcare assistants Mandatory 51.8 103/199 - - Provided on induction 71.4 142/199 - - Provided in the last 12 months 68.3 136/199 - t provided in the last 12 months 1 2/199 - Other allied healthcare professionals, e.g. physiotherapists, dieticians Mandatory 47.7 95/199 - - Provided on induction 64.8 129/199 - - Provided in the last 12 months 67.8 135/199 - t provided in the last 12 months 3.5 7/199 - Support staff in the hospital, e.g. housekeepers, porters, receptionists Mandatory 41.2 82/199 - - Provided on induction 57.8 115/199 - - Provided in the last 12 months 63.8 127/199 - - t provided in the last 12 months 11.1 22/199 National Audit of Dementia Round 3 Good Hope Hospital 35
Nutrition Items presented in this theme are from the organisational checklist and staff questionnaire. Questions relate to the provision of food and drink for people with dementia and hospital schemes such as protected mealtimes. Presentation of items and scoring For information on how the data tables in the chapters are laid out, please see page 8. The nutrition theme has an associated score. The score for your hospital and the national mean average are shown in table 6. For further information on scoring, please see page 6. Table 6: Nutrition score for your hospital Nutrition score () Good Hope Hospital 100 National average 83.8 National Audit of Dementia Round 3 Good Hope Hospital 36
I. Protected mealtimes Std 3.7 [1] 3.8 [1] 12 12a 12 SQ 13 7 SQ 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) 98 195/199 88.7 173/195 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 28.3 38.7 2488/8788 12/31, most of the time 39.3 35.5 3456/8788 11/31 New tool for, sometimes 16.8 22.6 Round 3 1476/8788 7/31 15.6 3.2 1368/8788 1/31 The hospital has in place a scheme/ programme which allows identified carers of 88.9 New question people with dementia to visit at any time 177/199 for Round 3 including at mealtimes (e.g. Carer s Passport): (y/n) 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. 51.2 71.4, always 6131/11978 30/42 27.3 21.4, most of the time 3271/11978 9/42 New tool for 16.1 4.8 Round 3, sometimes 1927/11978 2/42 5.4 649/11978 2.4 1/42 National Audit of Dementia Round 3 Good Hope Hospital 37
II. Catering arrangements Std N3b [2] 3.11 [2] 35 13 SQ 36 The hospital can provide finger foods for people with dementia (please select one option only): Patients can choose a complete meal option 65.3 (including vegetarian) that can be eaten 130/199 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 1 2/199 0 0/199 0 0/199 - - - New question for Round 3 Finger food consists of sandwiches/wraps only 33.7 67/199 - Patients who may be unable to use cutlery will 0 never be admitted to the hospital 0/199 - 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 38 42.4 3356/8822 14/33, most of the time 27.2 9.1 2398/8822 3/33 New tool for, sometimes 22.5 33.3 Round 3 1983/8822 11/33 12.3 15.2 1085/8822 5/33 The hospital 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 50.8 lighter hot dish(es) are available 24 hours a 101/199 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 10.6 21/199 32.2 64/199 3 6/199 3.5 7/199 - - - - New question for Round 3 National Audit of Dementia Round 3 Good Hope Hospital 38
Std 14 SQ Can you access snacks for people with dementia in between meals?, always 44.5 4060/9119, most of the time 28.7 2615/9119, sometimes 20.7 1886/9119 6.1 558/9119 48.5 16/33 21.2 7/33 18.2 6/33 12.1 4/33 New tool for Round 3 III. Communication Std N3a [2] 15 SQ Are the nutrition and hydration needs of people with dementia communicated at handovers/ safety briefings?, always 46.2 46.9 4199/9090 15/32, most of the time 33.4 34.4 3039/9090 11/32 New tool for, sometimes 15.5 12.5 Round 3 1408/9090 4/32 4.9 6.3 444/9090 2/32 IV. Overall Std 7.18 [1] 8 SQ 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 25.9 40.5 3181/12263 17/42, most of the time 50.1 40.5 6149/12263 17/42 New tool for, sometimes 19.2 14.3 Round 3 2357/12263 6/42 4.7 4.8 576/12263 2/42 National Audit of Dementia Round 3 Good Hope Hospital 39
Discharge Items presented in this theme are from the organisational checklist and the casenote audit. The questions ask about discharge planning, assessment for discharge and discharge notice. Presentation of items and scoring For information on how the data tables in the chapters are laid out, please see page 8. The discharge theme has an associated score. The score for your hospital and the national mean average are shown in table 7. For further information on scoring, please see page 6. Table 7: Discharge score for your hospital Discharge planning score () Good Hope Hospital 82 National average 72.7 National Audit of Dementia Round 3 Good Hope Hospital 40
I. Assessment before discharge Std 5.3 [2] 23 23a 24 25 25a 26 26a At the point of discharge the patient's level of cognitive impairment, using a standardised assessment, was summarised and recorded: (y/n) (If 23=) Please comment: Patient too unwell/ not responsive Patient has advanced dementia (i.e. patient s advanced dementia makes the assessment not appropriate) t routine/ not standard practice 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) Have there been any symptoms of delirium? (y/n) (If Q25=) Have the symptoms of delirium been summarised for discharge? (y/n) Have there been any persistent behavioural and psychiatric symptoms of dementia (wandering, aggression, shouting) during this admission? (y/n) (If Q26=) Have the symptoms of behavioural and psychiatric symptoms of dementia been summarised for discharge? (y/n) 22.4 1639/7329 3.3 189/5690 1.9 110/5690 5.8 331/5690 78.1 4444/5690 10.8 616/5690 69.1 5067/7329 32.3 2367/7329 47.9 1133/2367 19.4 1425/7329 44.5 635/1426 28.6 8/28 0 0/20 5 1/20 0 0/20 95 19/20 0 0/20 75 21/28 28.6 8/28 87.5 7/8 17.9 5/28 100 5/5 19.2 5/26 New question for Round 3 53.8 14/26 7.7 2/26 0 0/2 30.8 8/26 12.5 1/8 National Audit of Dementia Round 3 Good Hope Hospital 41
Std 5.5 [2] 27 27a (i) 27a (ii) 27a (i) 27a (iii) 27a (ii & iii) 36 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) An assessment of the carer's current needs has taken place in advance of discharge: (y/n/na) 65.5 1649/2519 70.4 1161/1649 11.9 138/1161 69.9 811/1161 18.3 212/1161 29.6 488/1649 29.1 142/488 70.9 346/488 66.2 1091/1649 33.8 558/1649 67.3 2605/3868 85.7 6/7 33.3 2/6 0 0/2 0 0/2 100 2/2 66.7 4/6 0 0/4 100 4/4 0 0/6 100 6/6 94.4 17/18 New question for Round 3 New question for Round 3 78.6 11/14 *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. I. Discharge planning and coordination Std 6.4 [2] 6.5 [2] 6.6 [3] 32 33a 33b There is a named person/ identified team who takes overall responsibility for complex needs discharge and this includes people with dementia: (y/n) (If Q32=) This person/ team has training in ongoing needs of people with dementia: (y/n) (If Q32=) This person/ team has experience of working with people with dementia and their carers: (y/n) 95.5 190/199 92.6 176/190 98.4 187/190 N/A N/A N/A N/A National Audit of Dementia Round 3 Good Hope Hospital 42
Std 6.4 [2] 5.4 [1] 5.6 [1] 5.7 [2] 5.8 [1] 28 29a 29b 29c 29d 30 31 32 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) 82 5807/7083 53.9 3327/6169 80.7 5597/6935 75.1 5501/7329 81.5 5971/7329 85.1 6234/7329 60.2 4211/6995 80.6 5621/6975 96.4 27/28 60 12/20 78.6 22/28 96.4 27/28 92.9 26/28 53.6 15/28 78.9 15/19 100 27/27 76 19/25 91.3 21/23 88.5 23/26 92.3 24/26 96.2 25/26 73.1 19/26 73.7 14/19 88.5 23/26 National Audit of Dementia Round 3 Good Hope Hospital 43
Std 5.1 [2] 34 34a 47.4 2483/5242 40.7 11/27 84 21/25 Was discharge planning initiated within 24 hours of admission? (y/n/na) (If Q34=N/A) Please select the recorded reason why discharge planning could not be initiated within 24 hours: Patient acutely unwell 62.5 100 0 1306/2088 1/1 0/1 Patient awaiting assessment 9.1 0 0 190/2088 0/1 0/1 Patient awaiting history/ results 6.1 0 0 127/2088 0/1 0/1 Patient awaiting surgery 9.6 0 0 200/2088 0/1 0/1 Patient presenting confusion 5.7 0 0 120/2088 0/1 0/1 Patient on end of life plan 0 0 1/2088 0/1 - Patient being transferred to another hospital 0.1 0 0 2/2088 0/1 0/1 Patient unresponsive 0.3 0 0 6/2088 0/1 0/1 Patient being discharged to nursing/ 6.5 0 0 residential care 136/2088 0/1 0/1 t recorded - - 0 0/1 Other 0 0 100 0/2088 0/1 1/1 II. tice of discharge Std N5a [3] 14 Instances where less than 24 hours notice of discharge has been given to carers or family are compiled and reported to the Executive Board: 4, within the past 6 months 8/199 New question 1.5 for Round 3, within the last year 3/199 National Audit of Dementia Round 3 Good Hope Hospital 44
Std 5.10 [2] N5b [2] 35 33 Carers or family have received notice of discharge and this is documented: Less than 24 hours 19.5 3.6 1432/7329 1/28 24 hours 12.2 14.3 897/7329 4/28 25-48 hours 14.7 32.1 1075/7329 9/28 More than 48 hours 27.1 28.6 1985/7329 8/28 notice at all 0.5 0 35/7329 0/28 t documented 24.2 21.4 1770/7329 6/28 carer, family, friend/ could not contact 1.8 0 132/7329 0/28 Patient specified information to be withheld Was a copy of the discharge plan/ summary sent to the GP/ primary care team on the day of discharge? (y/n/na) 0 3/7329 93.6 6701/7156 0 0/28 100 28/28 11.5 3/26 15.4 4/26 26.9 7/26 42.3 11/26 0 0/26 0 0/26 3.8 1/26 New answer option for Round 3 New question for Round 3 National Audit of Dementia Round 3 Good Hope Hospital 45
Governance Items presented in this theme are from the organisational checklist, staff questionnaire and carer questionnaire. The questions relate to such topics as the environment in the hospital, involvement of the executive board, services available to carers and patients and engagement with carers. Presentation of items and scoring For information on how the data tables in the chapters are laid out, please see page 8. The governance theme has an associated score. The score for your hospital and the national mean average are shown in table 8. For further information on scoring, please see page 6. Table 8: Governance score for your hospital Governance score () Good Hope Hospital 43.8 National average 65.1 National Audit of Dementia Round 3 Good Hope Hospital 46