According to The Royal College of Psychiatrists 95% of hospitals do not have mandatory training in dementia awareness for all staff whose work is likely to bring them into contact with patients with dementia.
The report into the care received by nearly 8,000 patients with dementia in 206 hospitals in England and Wales has also revealed that many patients with dementia are not having assessments of their mental health or state of nutrition and that there are serious delays for patients referred to in-hospital psychiatry liaison services.
Findings of the clinical audit – commissioned by the Healthcare Quality Improvement Partnership and conducted by a project team at The Royal College of Psychiatrists’ Centre for Quality Improvement – are also surprising in the current financial climate. The National Audit Office reported in 2007 that each hospital could save an average £6 million a year by correctly identifying dementia patients, providing more appropriate and timely care, thus reducing length of stay and improving health outcomes.
750,000 people in the UK have dementia and up to one in four hospital beds are occupied by an older person who has dementia (see ‘key facts on dementia in the UK’ below). The Interim Report from the first annual National Audit of Dementia examined the care provided by 206 hospitals across England and Wales to 7,934 patients, discharged from hospital between 1 September 2009 and 28 February 2010.
KEY FINDINGS FROM THE NATIONAL AUDIT OF DEMENTIA INTERIM REPORT:
* 95% of hospitals do not have mandatory training in dementia awareness for all staff whose work is likely to
bring them into contact with patients with dementia.
* About one-third of patients did not have a nutritional assessment recorded during their admission.
* Fewer than one-half of patients received a formal mental status test upon admission to hospital.
* One-third of patients referred to in-hospital psychiatry liaison services not seen within 96 hours.
* Fewer than one in ten hospital executive boards regularly review readmission data for patients with dementia
and only one in five regularly review information on delayed patient transfers.
KEY FINDINGS FROM THE SURVEY OF 206 HOSPITALS:
* Only 30% of hospitals have formal system for gathering pertinent personal information to caring for person
* Just 8% of hospital executive boards regularly review readmission data for patients with dementia
* 20% of hospital executive boards regularly review information collected on delayed transfers of people
* 70% of hospitals do not have a review process for discharge procedures for people with dementia
* 69% of hospitals were not able to identify people with dementia within reported information on in-hospital falls
and their causes
* 84% of hospitals said all staff working with people with dementia and older adults had training in protection
of vulnerable adults
* 77% of hospitals do not have a training strategy identifying key skills for working with people with dementia
* 95% of hospitals do not have mandatory training in dementia awareness for all staff
* Just 19% of hospitals had a system to ensure ward staff were aware that a person had dementia
and how it affected them, and that necessary information was imparted to other staff with whom the person
came into contact
KEY FINDINGS FROM THE REVIEW OF CASENOTES OF 7,934 PATIENTS:
* Just 41% of patients received a standard mental status test during admission to hospital
* While 90% of participating hospitals provided access to a liaison psychiatry service who can help provide diagnosis, review of care and medication and appropriate discharge planning, just 40% of those referred were seen within 48 hours and 36% had not been seen after 96 hours
* While rates of provision of support from hospitals for carers of those with dementia were reasonably high, casenotes results showed that 26% of hospitals did not carry out assessments of the carer’s current needs in advance of discharge
* Although it was policy in 96% of the hospitals that all patients with dementia have an assessment made of their nutritional status, the audit of casenotes found that this did not happen for 30% of the patients in the national sample.
KEY FACTS ON DEMENTIA IN THE UK:
* Up to one in four hospital beds at any one time is occupied by a person over the age of 65 who has dementia (source: Counting the Cost, Alzheimer’s Society, 2009).
* About 750,000 people in the UK have dementia (16,000 of these people are under 65).
* One in 14 people over 65 years of age and one in six people over 80 has a form of dementia (see Alzheimer’s Society position statement, updated January 2010).
* Counting the Cost found that people with dementia stay longer in hospital than others who go in for the same procedure. The longer people with dementia are in hospital, the worse the effect on the symptoms of dementia and the individual's physical health
Issues in this article may be of interest to you, and/or affect your organisation or your employees or colleagues. Healthcare e-Academy courses may provide some background information or training on related subjects. A course which may be relevant to the above issues is our Dementia Awareness course. For more information, support or advice, please contact