People with dementia in hospital in England and Wales often do not receive key health assessments, according to the second report of the National Audit of Dementia.
Although the audit found that there has been positive change since the first report in 2011, it showed that problems with assessments remain. For instance many patients with dementia develop acute confusion during a stay in hospital, but less than half of the 7,987 patients in the audit sample had been assessed for delirium, and only half had received an assessment of their mental state.
The audit report describes these assessment rates as “alarmingly low”. It also found that a third of hospitals do not have guidance in place on involving the person’s carer and sharing information with them.
George McNamara, head of policy and public affairs at the Alzheimer's Society, said: "Given that people with dementia occupy a quarter of hospital beds, it is scandalous that improving dementia care is not a top priority for a number of hospital managers."
The charity's call for hospitals to do more to give staff the training they needed to look after patients with dementia better was supported by research in the audit.
Other key findings from the report included:
· 41% of hospitals do not include dementia awareness training in staff induction. In addition, 40% of hospitals did not provide any awareness training to support staff such as receptionists in the 12 months prior to audit, and 11% did not provide this training to nurses
· 36% of hospitals now have a care pathway in place for people with dementia – up from 6% - and a further 51% have one in development
· Less than 50% of hospital executive boards are routinely involved in scrutinising hospital performance data on delayed discharges, readmissions and falls
· Information important to future care is not being provided at the point of discharge
· In a quarter of case notes, there was no record that notice of discharge from hospital had been given to carers or family
· Case notes often do not include information that could help staff communicate better with the patient.
However, the report does show improvements in several aspects of care since the first report was published in 2011.
For example, there has been a 10% drop in the overall number of prescriptions of antipsychotic drugs and patients are now more likely to receive an assessment of their nutrition.
The audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Psychiatrists’ (RCPsych) Centre for Quality Improvement in partnership with other organisations. The audit looked at data collected from 210 hospitals across England and Wales, including case notes of 7,987 patients with a diagnosis or current history of dementia.
With a further RCPsych Centre for Quality Improvement audit due by the end of 2015, recommendations on next steps include:
· Dignity leads, dementia champions and dementia specialist nurses should be employed in all hospitals
· Ward managers should ensure that there is clear leadership and supervision available to staff on the ward regarding the care of people with dementia
· A personal information document should be in use throughout the hospital to ensure that staff are aware of each patient’s individual needs and preferences
· Any instances of discharge of people with dementia from hospital after midnight, or when carers/family receive less than 24 hours’ notice, should be reported to and reviewed by Trust Boards
· Hospital chief executives should ensure routine audit of in-hospital antipsychotic prescribing is carried out, allowing for comparison of practice between wards and departments
· The director of nursing in each hospital should regularly review protected mealtimes in the hospital
· Commissioners/Health Boards should ensure that liaison psychiatry services are in place to provide adequate access over 24 hours for treatment and referral of people with dementia in hospital.
Professor John Young, national clinical director for integration and frail elderly, concluded: “Hospitals are at last engaging with the special care requirements and important progress has been made across several fronts but many care gaps remain to be addressed."