Non-cognitive symptoms and behaviour that challenges

Quality statement

People with dementia who develop non-cognitive symptoms that cause them significant distress, or who develop behaviour that challenges, are offered an assessment at an early opportunity to establish generating and aggravating factors. Interventions to improve such behaviour or distress should be recorded in their care plan.

Quality measure

Structure

a) Evidence that people with dementia who develop non-cognitive symptoms that cause them significant distress, or who develop behaviour that challenges, are offered an assessment at an early opportunity.

b) Evidence that individually tailored care plans, that help carers and staff address the behaviour that challenges, are recorded in the notes and reviewed regularly.

Process

a) Proportion of people with dementia who develop non-cognitive symptoms that cause them significant distress, or who develop behaviour that challenges, who receive an assessment to establish likely factors that may generate, aggravate or improve such distress or behaviour.

Numerator: the number of people who receive an assessment.

Denominator: the number of people with dementia who develop non-cognitive symptoms that cause them significant distress or who develop behaviour that challenges.

b) Proportion of people with dementia who develop non-cognitive symptoms that cause them significant distress, or who develop behaviour that challenges, with an individualised care plan identifying actions to address the distress or behaviour.

Numerator: the number of people with an individualised care plan identifying actions to address the distress or behaviour.

Denominator: the number of people with dementia who develop non-cognitive symptoms that cause them significant distress or who develop behaviour that challenges.

c) Proportion of people with dementia with mild-to-moderate non-cognitive symptoms who are prescribed anti-psychotic medication. (Goal to be 0% reflecting the Department of Health report on the use of anti-psychotic medication for people with dementia and its aim to reduce the use of anti-psychotic medication for people with dementia.)

Numerator: the number of people prescribed anti-psychotic medication.

Denominator: the number of people with dementia with mild-to-moderate non-cognitive symptoms.

Description of what the quality statement means for each audience

Service providers ensure that all people with dementia who develop non-cognitive symptoms that cause significant distress, or who develop behaviour that challenges, are given a comprehensive assessment.

Health and social care professionals working with people with dementia who develop non-cognitive symptoms carry out a comprehensive assessment. A behavioural and functional analysis should be conducted by health and social care professionals with specific skills, in conjunction with carers and care workers, and an individually tailored care plan should be developed to address the issues.

Commissioners ensure local service providers are adequately resourced and trained to undertake comprehensive assessment and management of people with non-cognitive symptoms of dementia.

People with dementia who develop non-cognitive symptoms that cause them significant distress or who develop behaviour that challenges can expect to be offered a comprehensive assessment at an early stage.

Definitions

The assessment must include:

• the person's physical health
• depression
• possible undetected pain or discomfort
• side effects of medication
• individual biography, including religious beliefs and spiritual and cultural identity
• psychosocial factors
• physical environmental factors
• behavioural and functional analysis conducted by professionals with specific skills, in conjunction with carers and care workers.

Data source

Structure

Local data collection.

Process

a) and b) Local data collection. Contained within NICE CG42 audit support, criterion 8.

c) Local data collection. Acute Trusts can collect data on the main recorded reason for any prescription of antipsychotic medication using the National Audit of Dementia casenote audit, section 2 (however, the audit is not specific to people with mild-to-moderate non-cognitive symptoms).