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National Audit of Dementia Care in General Hospitals 2012-13

Second Round Audit Report and Update

At any one time, a quarter of acute hospital beds are in use by people with dementia. The National Audit of Dementia was established in 2008 with funding from the Healthcare Quality Improvement Partnership to examine the quality of care delivered to this growing sector of the community who are likely to be particularly vulnerable to care shortfalls

In 2011 our baseline report showed disappointing results overall and a lack of attention to basic care needs. Nutritional assessments, for example, were undertaken in fewer than 10% of patients in some hospitals.

Throughout both rounds of audit, dementia care has been a high priority at government level in both England and Wales. Improving acute hospital care is a priority in the 2012 Prime Minister’s Dementia Challenge16 and in the Welsh Government’s 1000 Lives Plus programme28. National, local and regional initiatives have maintained a focus on dementia, supported by dedicated input from hospital staff.

This second round of audit demonstrates general hospitals can make changes which improve the quality of care provided to people with dementia. That said, performance in the 2010 audit set a fairly low baseline, which means that despite significant positive change, many best practice standards remain unmet.

There are positive findings within this report. Dementia champions are now in place in most hospitals, and the majority of hospitals have begun to collect personal information about people with dementia to help improve care. More people with dementia are now having their essential health needs assessed and we are seeing dementia care feature much more in hospital training strategies. A reduction in the use of antipsychotic drugs, some of which increase risk of death, was found. These are all welcome steps forward.

Further improvement is required and there remains a gap between written policies and actual practice. Too few patients are being assessed for delirium risk and for cognitive function, and may therefore fail to receive vital care. Despite more systematic collection of personal information about patients’ needs, preferences and communication requirements, this is often not recorded in the patient notes, so staff remain unaware of how best to care for the individual. Discharge plans often fail to record important details about ongoing health needs. At the point of audit, only 36% of hospitals had a fully developed care pathway in place, and we recommend that hospitals now address this with urgency. In terms of dementia awareness, there remains a huge need for much better staff training and support if we are to provide comprehensive, safe and dignified dementia care across the board.