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Dementia: supporting people with dementia and their carers in health and social care [CG42]

Measuring the use of this guidance

Recommendation: 1.1.1.4

Health and social care staff should identify the specific needs of people with dementia and their carers arising from ill health, physical disability, sensory impairment, communication difficulties, problems with nutrition, poor oral health and learning disabilities. Care plans should record and address these needs

What was measured: Case notes that had a section dedicated to gathering information from the carer within the care assessment notes
Data collection end: October 2012
44.9%
Number that met the criteria: 3589 / 7987
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Hospitals that had a formal system in place for gathering information pertinent to caring for a patient with dementia
Data collection end: October 2012
73.8%
Number that met the criteria: 155 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Case notes that had a section dedicated to gathering information from the carer within the care assessment notes
Data collection end: November 2016
57%
Number that met the criteria: 5727 / 10010
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Hospitals that had a formal system in place for gathering information pertinent to caring for a patient with dementia
Data collection end: November 2016
99%
Number that met the criteria: 196 / 199
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.1.5

Health and social care staff, especially in residential settings, should identify and, wherever possible, accommodate the preferences of people with dementia and their carers, including diet, sexuality and religion. Care plans should record and address these preferences.

What was measured: The proportion of case notes that detail information collected about food and drink preferences of the person with dementia.
Data collection end: November 2016
44%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.4.2

Health and social care professionals should inform people with dementia and their carers about advocacy services and voluntary support, and should encourage their use. If required, such services should be available for both people with dementia and their carers independently of each other.

What was measured: The proportion of hospitals with access to an advocacy service for people with dementia.
Data collection end: October 2012
85%
Data collection end: November 2016
95%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.4.3

People with dementia should be given the opportunity to convey information to health and social care professionals involved in their care in a confidential manner. Professionals should discuss with the person any need for information to be shared with colleagues and/or other agencies. Only in exceptional circumstances should confidential information be disclosed to others without the person's consent. However, as dementia worsens and the person becomes more dependent on family or other carers, decisions about sharing information should be made in the context of the Mental Capacity Act 2005 and its Code of Practice. If information is to be shared with others, this should be done only if it is in the best interests of the person with dementia.

What was measured: Hospitals that reported having clear guidelines on making sure the carer knows what information will be shared with them
Data collection end: October 2012
65.7%
Number that met the criteria: 138 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.7.3

Care managers and care coordinators should ensure the coordinated delivery of health and social care services for people with dementia. This should involve: • a combined care plan agreed by health and social services that takes into account the changing needs of the person with dementia and his or her carers • assignment of named health and/or social care staff to operate the care plan • endorsement of the care plan by the person with dementia and/or carers • formal reviews of the care plan, at a frequency agreed between professionals involved and the person with dementia and/or carers and recorded in the notes.

What was measured: Hospitals have a system to ensure carers are advised about obtaining a carers assessment
Data collection end: October 2012
67.14%
Number that met the criteria: 141 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Case notes analysed that had a record of the assessment of the carers current needs
Data collection end: October 2012
71.73%
Number that met the criteria: 2337 / 3258
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Hospitals have a system to ensure carers are advised about obtaining a carers assessment
Data collection end: November 2016
67%
Number that met the criteria: 2605 / 3868
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.9.1

Health and social care managers should ensure that all staff working with older people in the health, social care and voluntary sectors have access to dementia-care training (skill development) that is consistent with their roles and responsibilities

What was measured: Hospitals that had a training and knowledge framework that identifies necessary skill development in working with and caring for people with dementia
Data collection end: October 2012
78.1%
Number that met the criteria: 164 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Hospitals reported staff induction programmes that include dementia awareness
Data collection end: October 2012
59.05%
Number that met the criteria: 124 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Proportion of acute trusts that have specific dementia training for all staff caring for older people.
Data collection end: October 2015
89%
Area covered: England
Source: NHS Benchmarking Network. Older People’s Care in Acute Settings Benchmarking Report.

What was measured: Hospitals that had a training and knowledge framework that identifies necessary skill development in working with and caring for people with dementia
Data collection end: November 2016
96%
Number that met the criteria: 190 / 199
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: The proportion of hospitals providing dementia awareness training to nurses.
Data collection end: October 2012
89%
Data collection end: November 2016
100%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: The proportion of hospitals providing dementia awareness training to healthcare assistants.
Data collection end: October 2012
90%
Data collection end: November 2016
100%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: The proportion of hospitals providing dementia awareness training to allied healthcare professionals
Data collection end: October 2012
79%
Data collection end: November 2016
98%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: The proportion of hospitals providing dementia awareness training to doctors.
Data collection end: October 2012
79%
Data collection end: November 2016
93%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: The proportion of hospitals providing dementia awareness training to support staff.
Data collection end: October 2012
60%
Data collection end: November 2016
91%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.9.4

Liaison teams from local mental health and learning disability services should offer regular consultation and training for healthcare professionals in acute hospitals who provide care for people with dementia. This should be planned by the acute hospital trust in conjunction with mental health, social care and learning disability services

What was measured: Hospitals reporting mental health liaison teams providing training for ward staff
Data collection end: October 2012
64.76%
Number that met the criteria: 136 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.11.2

Acute trusts should ensure that all people with suspected or known dementia using inpatient services are assessed by a liaison service that specialises in the treatment of dementia. Care for such people in acute trusts should be planned jointly by the trust's hospital staff, liaison teams, relevant social care professionals and the person with suspected or known dementia and his or her carers.

What was measured: Hospitals that reported having access to liaison psychiatry service
Data collection end: October 2012
94.29%
Number that met the criteria: 198 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Of those hospitals with a liaison service, those able to provide an emergency or urgent assessment
Data collection end: October 2012
84.85%
Number that met the criteria: 168 / 198
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Assessed case notes that contained a referral to liaison psychiatry
Data collection end: October 2012
16.3%
Number that met the criteria: 1291 / 7916
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.2.1.2

Health and social care managers should coordinate and integrate working across all agencies involved in the treatment and care of people with dementia and their carers, including jointly agreeing written policies and procedures. Joint planning should include local service users and carers in order to highlight and address problems specific to each locality

What was measured: Hospitals that had a process in place to regularly review hospital discharge policy and procedures for people with dementia
Data collection end: October 2012
53.81%
Number that met the criteria: 113 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.4.2.1

A basic dementia screen should be performed at the time of presentation, usually within primary care. It should include: routine haematology biochemistry tests (including electrolytes, calcium, glucose, and renal and liver function) thyroid function tests serum vitamin B12 and folate levels.

What was measured: Proportion of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded between 6 months before or after entering on to the register.
Data collection end: July 2015
74.7%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.


Recommendation: 1.7.1.1

"People with dementia who develop non‑cognitive symptoms that cause them significant distress or who develop behaviour that challenges should be offered an assessment at an early opportunity to establish likely factors that may generate, aggravate or improve such behaviour. The assessment should be comprehensive and 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. Individually tailored care plans that help carers and staff address the behaviour that challenges should be developed, recorded in the notes and reviewed regularly. The frequency of the review should be agreed by the carers and staff involved and written in the notes."

What was measured: The proportion of case notes that detailed information collected about factors that can calm the person with dementia if agitated.
Data collection end: November 2016
28%
Number that met the criteria: 1564 / 5539
Data collection end: November 2016
25%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.7.3.1

Health and social care staff who care for people with dementia should identify, monitor and address environmental, physical health and psychosocial factors that may increase the likelihood of behaviour that challenges, especially violence and aggression, and the risk of harm to self or others. These factors include: • overcrowding • lack of privacy • lack of activities • inadequate staff attention • poor communication between the person with dementia and staff • conflicts between staff and carers • weak clinical leadership

What was measured: Of those that had a protocol (n=128), the proportion that had restraint and sedation used only as a final option
Data collection end: October 2012
97%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Of those that had a protocol (n=128), the proportion that outlined physical causes which may cause challenging behaviour in people with dementia
Data collection end: October 2012
95%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Of those that had a protocol (n=128), the proportion that outlined environmental factors that may contribute to challenging behaviour
Data collection end: October 2012
91%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.7.3.2

Health and social care staff should be trained to anticipate behaviour that challenges and how to manage violence, aggression and extreme agitation, including deescalation techniques and methods of physical restraint

What was measured: Of those that had a protocol (n=128), the proportion of hospitals that outlined the possibilities of de-escalation techniques
Data collection end: October 2012
94%
Number that met the criteria: / 128
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.7.3.3

Healthcare professionals who use medication in the management of violence, aggression and extreme agitation in people with dementia should: • be trained in the correct use of drugs for behavioural control, specifically benzodiazepines and antipsychotics • be able to assess the risks associated with pharmacological control of violence, aggression and extreme agitation, particularly in people who may be dehydrated or physically ill • understand the cardiorespiratory effects of the acute administration of benzodiazepines and antipsychotics and the need to titrate dosage to effect • recognise the importance of nursing people who have received these drugs in the recovery position and of monitoring pulse, blood pressure and respiration • be familiar with and trained in the use of resuscitation equipment • undertake annual retraining in resuscitation techniques • understand the importance of maintaining an unobstructed airway.

What was measured: Proportion of hospitals reporting having a protocol in place governing the use of interventions for patients who present with behavioural and psychological symptoms of dementia
Data collection end: October 2012
61%
Number that met the criteria: 128 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: proportion of hospitals report having a protocol in development governing the use of interventions for patients who present with behavioural and psychological symptoms of dementia
Data collection end: October 2012
30%
Number that met the criteria: 63 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Of those that had a protocol (n=128), the proportion of hospitals that was in line with NICE recommendations for the administration of anti-psychotic drugs
Data collection end: October 2012
84%
Number that met the criteria: / 128
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Of those that had a protocol (n=128),the proportion where the protocol included the risks that must be taken into account before sedation or restraint
Data collection end: October 2012
88%
Number that met the criteria: / 128
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.10.1.4

Health and social care staff should encourage people with dementia to eat and drink by mouth for as long as possible. Specialist assessment and advice concerning swallowing and feeding in dementia should be available. Dietary advice may also be beneficial. Nutritional support, including artificial (tube) feeding, should be considered if dysphagia is thought to be a transient phenomenon, but artificial feeding should not generally be used in people with severe dementia for whom dysphagia or disinclination to eat is a manifestation of disease severity. Ethical and legal principles should be applied when making decisions about withholding or withdrawing nutritional support.

What was measured: Proportion of hospitals that reported having procedures for assessing nutritional assessment
Data collection end: October 2012
100%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Proportion of case notes analysed that had evidence of nutritional assessment being performed
Data collection end: October 2012
89%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Proportion of case notes analysed that had evidence of BMI / weight being recorded
Data collection end: October 2012
81%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Proportion of hospitals that reported procedures in place for recording BMI / weight
Data collection end: October 2012
99%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Proportion of case notes analysed that had evidence of nutritional assessment being performed
Data collection end: November 2016
90%
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.



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