Dementia hospital care in need of radical shake up

Dementia hospital care in need of 'radical shake-up'

By Charlotte Fantelli

Significant improvements are needed in the care of dementia patients, according to the first full report of the National Audit of Dementia. The audit was commissioned by Healthcare Quality Improvement Partnership (HQIP) and included data collected from 210 hospitals across England and Wales. Findings from the audit prove that changes are needed to ensure quality of care to these most vulnerable of patients. Under scrutiny were ward environments, staff training and the approach to care delivery for patients with dementia.

The audit that was carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement in partnership with other organisations found that shockingly less than a third of staff on audited wards said that their training and development in dementia care was 'sufficient'. One staff member surveyed said: “I have never had any training related to caring with patients with dementia or Alzheimer’s. As staff have not had training, I feel that these patients do not receive the specialised attention that they deserve, or understanding and time from staff.” This lack of training may explain the findings that show and 'impersonal approach to care' that often left the patient with a lack of understanding or choice.  

While most wards did meet basic safety requirements, most failed to put in place simple things that could help dementia sufferers when facing new and unfamiliar surroundings. 

Key findings taken directly from the report include:

  • Only 6% of hospitals had a care pathway in place for people with dementia – although 44% had one in development at the time of the audit.
  • Only 32% of staff said that their training and development in dementia care was sufficient. Interim audit findings released last year showed that only 5% of hospitals had mandatory awareness training for their staff.
  • 50% of staff felt they had not received sufficient training in communication skills specific to people with dementia, and 54% felt they had not received sufficient training in dealing with challenging or aggressive behaviour.
  •  Very few wards demonstrated a culture which was “person-centred” – this is one which treats the person with dementia as an individual and takes their perspective into account in a supportive environment.
  • 59% of wards reported that personal items (such as family photographs or cards) were not situated where the patient could see them for reassurance.
  • Only 15% of wards used colour schemes to help patients with dementia find their way around the ward. Only 38% of wards said that signs in the ward were large, bold and distinctive.

Chair of the National Audit of Dementia Steering Group, Professor Peter Crome, said: “This report provides further concrete evidence that the care of patients with dementia in hospital is in need of a radical shake-up. We have a provided a number of recommendations that if implemented will enable patients and their families to have confidence in their hospital treatment. It is good to see that several hospitals have responded to the results of the interim findings with programmes of quality improvement. Hopefully real change will be seen in the results of the next national audit, which is due to be published in June 2013.”

The recommendations taken from the report include:

  • A Senior Clinical Lead for dementia should be in place in each hospital with designated time in their job role to develop, implement and review the dementia pathway. These clinicians should identify Dementia Champions in each department in the hospital and at ward level.
  • Ward managers should make sure that staff can involve people with dementia and their carers in discussions on care, treatment and discharge.
  • All staff should be provided with basic training in dementia awareness, and a specified proportion of ward staff should receive higher level training.
  • Assessment of staffing levels must take account of the additional support needs of people with dementia.
  • Systems for guidance, supervision and support should be in place for staff caring for people with dementia.
  • Health departments in England and Wales should provide guidance on dementia-friendly ward design. These should be incorporated as standard into all refurbishments and new-builds.
  • Simple and effective improvements to the environment should be carried out in all wards admitting older people, including orientation aids such as colour schemes and personalising bed areas.

Many hospitals have already begun to take onboard these findings and have looked into ways of implementing change. 59 hospitals have agreed to awareness training for staff while 36 hospitals have are reviewing or developing the care pathway. Other hospitals have agreed to take on board these recommendations and staff on audited wards are working on actions to improve the who experience of care for dementia patients.

Dr Kevin Stewart, Clinical Director of the Royal College of Physicians’ Clinical Effectiveness and Evaluation unit, said: “We have a lot of work to do to make sure that patients with dementia get the best possible care in hospital. They deserve no less, and we are delighted that the NHS in England has made the care of this group one of its top priorities”

Let us hope that by identifying the deficiencies in care, those responsible can really get to see the changes that must be made. Dementia sufferers are some of the most vulnerable adults in our society and their needs have long been insufficiently met. Mental Healthy await the 2013 audit with the hope that improvements have been found.

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