norfolk-and-norwich-university-hospital_report

National Audit of Dementia Care in general hospitals 2018-2019 Norfolk and Norwich University Hospital Norfolk and Norwich University Hospital Trust Local report Authors This report was prepared by Chloë Hood, Aimee Morris, Samantha Ofili, Jhermaine Capistrano and Jessica Butler Content is advised and approved by all members of the Steering Group Please see our website for full details of the Steering Group members and the Project Team Acknowledgements We would like to thank everyone who contributed to this report We would especially like to mention:   Partner Organisations Age UK Alzheimer’s Society British Geriatrics Society (BGS) John’s Campaign National Dementia Action Alliance (NDAA) Royal College of Nursing (RCN) Royal College of Physicians (RCP)   The carers for people with dementia and staff working in hospitals who completed a questionnaire for this round of the audit The audit leads, champions, and clinical audit staff for their hard work organising the data collection in their hospitals (A list of participating hospitals is on our website) The participants in the Service User Review Panels held following Round 3, for their contribution to the content of Round (a report on the panel discussions is on our website) All the members of the Steering Group and especially our Chair, Peter Crome Artwork Cover design features A Walk in the Country by Harry Bridgman All entries in the NAD art prize can be seen on our website We would like to thank all entrants for sending us their impressive work and permitting us to display it This report should be cited as: Royal College of Psychiatrists, (2019) National Audit of Dementia care in general hospitals 2018-19: Round Four audit local report London: Royal College of Psychiatrists © Healthcare Quality Improvement Partnership Ltd (HQIP) 2019 Table of Contents Introduction 6  Background   6  Data collection   6  Audit standards   6  How the findings are presented 7  Key findings 7  National key findings 8  Key findings and your hospital 9  Key finding: assessments for delirium 9  Key recommendations: Delirium   10  Key finding: personal information collected to support care 11  Key recommendation: Personal information   14  Key finding: dementia awareness training 15  Key recommendation: Dementia awareness training   16  Key finding: Trust/Health Boards involvement in dementia care 17  Key recommendation: Trust/Health Boards involvement in dementia care  . 17  Key finding: overall improvement in care in general hospitals 18  Key recommendation:   19  Data breakdown by audit theme 20  Data tables in audit theme chapters  . 21  Carer Rating of Patient Care 22  Assessment 23  Multidisciplinary assessment   23  Mental state assessment   24  Information and Communication 25  Using personal information to improve care   25  Availability of personal information   25  Involvement of carers and people with dementia   27  Staff communication  . 28  Use of information systems  . 28  Staffing and Training 30  Staffing levels  30  Guidance for staff   31  Training and knowledge framework  31  Dementia training formats   31  Staff data on dementia training   32  Nutrition 34  Mealtimes policies and initiatives   34  Finger foods and 24-hour food services 34  Communication of nutrition and hydration needs 36  Overall 36  Governance 37  Care pathway   37  Reviewing dementia care in hospitals  . 38  Continuity of care   39  Specialist services for dementia care   39  Engagement with carers   40  Environment   40  Discharge 43  Discharge coordination   43  Discharge planning   43  Involving the person with dementia in decision making   45  Carer involvement and support . 45  Assessment before discharge   46  Staff Suggestions and Carer Comments 48  Staff Suggestions 48  Carer comments 48  Staff Suggestions 49  Carer Comments 51  Recommendations 53  Assessment   53  Information and communication   53  Staffing and training   53  Nutrition   54  Discharge   54  Governance  . 54  Overall  . 55  References 56  Appendices 57    List of Figures and Tables Figure 1: Initial assessment for indications of delirium 9  Figure 2: Percentage of casenotes where information about the person with dementia had been collected National sample and your hospital sample 11  Figure 3: Results from the ‘mini audit’ on personal information documents 12  Figure 4: Carers’ perspective on how well informed staff were about the needs of the person with dementia 12  Figure 5: Staff perspective on the availability of personal information to help them care for/support people with dementia 13  Figure 6: Staff perspective on the opportunity to use personal information when available to help them care for/support people with dementia 13  Figure 7: Staff response on level of preparedness following training provided by their current hospital 16  Figure 8: Your hospital’s scores against the national range 19  Table 1: National and Norfolk and Norwich University Hospital’s data received per hospital in Round of the audit 6  Table 2: Full assessment for delirium 9  Table 3: Number of staff equipped with at least Tier 1/basic awareness training between 1st April 2017 and 31st March 2018 15  Table 4: Proportion of staff reporting that they received some form of dementia training from the hospital they currently work at and what form of training(s) 15  Table 5: Trust/Health Board involvement when reviewing information 17  Table 6: Your hospital’s scores and rankings 18  Table 7: Explanation of how data tables are presented in audit theme chapters 21  Table 8: Explanation of how comments and suggestions are presented in tables 48  Introduction Background The National Audit of Dementia (NAD) care in general hospitals examines aspects of care received by people with dementia in general hospitals in England and Wales The audit is commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England/NHS Improvement and the Welsh Government, as part of the National Clinical Audit Programme The audit is managed by the Royal College of Psychiatrists in partnership with:  Age UK  Alzheimer’s Society  British Geriatrics Society (BGS)  John’s Campaign  National Dementia Action Alliance (NDAA)  Royal College of Nursing (RCN)  Royal College of Physicians (RCP) Data collection Round of NAD collected data between April and October 2018 The audit was open to all general acute hospitals in England and Wales providing acute services on more than one ward which admit adults over the age of 65 In England and Wales, 195 hospitals (97% of eligible hospitals) took part in this round, a list of participating hospitals is on our website Participating hospitals were asked to complete:  A hospital level organisational checklist  A retrospective casenote audit with a minimum target of 50 sets of patient notes  A survey of carer experience of quality of care  A staff questionnaire on providing care and support to people with dementia Table 1: National and your hospital’s data received in Round of the audit Tool National Organisational checklist 195 Casenotes 9782 Staff questionnaires 14154 Carer questionnaires 4736 Your hospital 50 110 22 Audit standards The NAD measures the performance of general hospitals against standards relating to care delivery which are known to impact upon people with dementia while in hospital These standards are derived from national and professional guidance, including NICE Quality Standards and guidance, the Dementia Friendly Hospitals charter, and reports from Alzheimer’s Society, Age UK and Royal Colleges A full list of these standards and associated references can be found in the ‘Round resources’ section on the NAD website National Audit of Dementia | Local report | 6  National Audit of Dementia | Local report | How the findings are presented This local report contains a full presentation of your results for Round of the NAD alongside the national results from all participating hospitals If your hospital participated in Round 3, these results are also shown where applicable The national data and data from your hospital are presented in three ways in this report: Key findings, scores and recommendations from this round’s National Report A full breakdown of your data by audit theme Staff suggestions and carer comments for your hospital Hospitals which submitted less than five carer or staff questionnaires have not received any data in their local report in order to protect anonymity Hospitals which submitted five to nine of either questionnaire have not received the demographic information for that questionnaire Key findings This section of the report presents some of the data and recommendations associated with the key findings in Round For local reporting, we have included graphical representations of data related to the key findings to allow for comparison between your hospital and the national results Each figure shows the national mean average results next to the data for your hospital to allow for easy comparison All percentages have been rounded up to a whole number which means some results may calculate to just under or over 100% The national averages include data collected from 195 hospitals across England and Wales Null responses were not included at both national and hospital level, therefore sample sizes can differ between questions from the same tool The exact sample sizes for both the national sample and the sample for your hospital are presented in the graphs Very low sample sizes (below ten) should be interpreted with caution National Audit of Dementia | Local report | 7  National Audit of Dementia | Local report | National key findings Shown below are the five key findings derived from the national data set for the fourth round of the National Audit of Dementia     of casenotes had an     on admission             collected in casenotes to support care:       noted factors which noted actions which   cause distress could calm or reassure         of hospitals were able to submit data on the number     of staff who had received Tier 1/informed             Trusts/Health Boards can identify the proportion of people with dementia who   experience:   re  delayed inpatient   admissions discharges   falls of   of   Trusts/Health Boards Trusts/Health Boards   of Trusts/Health Boards         Overall, many results show from   those reported in Round (2017)       58% initial assessment or delirium noted Personal information 36% 32% 53% dementia awareness training 64% 37% 40% improvements National Audit of Dementia | Local report | 8  National Audit of Dementia | Local report | Key findings and your hospital Key finding: assessments for delirium Effective prevention, diagnosis and management of delirium in people with dementia admitted to hospital is essential People with dementia are at considerable risk of developing delirium1 When delirium is superimposed on dementia, it can be challenging to distinguish2 As a result, it is important that hospitals have robust mechanisms in place for identifying indications of delirium in people with dementia Figure 1: Initial assessment for indications of delirium 100% 90% 80% Casenotes 70% 60% 50% 40% 30% 54 20% 10% 0% 31 10 Single Question in Delirium (SQiD) History taken from someone who knows the patient well 4AT Other Initial Assessment for delirium National average % Your hospital % (n=50) NB: patient(s) had delirium noted on admission and were also considered to have an initial assessment for indications of delirium (See Q21 CA in Assessment data tables for your hospital comparison to Round 3) NICE guidelines for delirium1 specify that when indications of delirium are identified a clinical assessment should be carried out to confirm diagnosis Table 2: Full assessment for delirium Initial assessment for indications of delirium Clinical assessment following indications of delirium National average % 58% (n=9147) 66% (n=2458) Your hospital % 62% (n=50) 25% (n=16) NB: patient(s) was/were not included in the initial assessment figure as they went straight to assessment Those who could not be assessed for recorded reasons were excluded from the clinical assessment figure National Audit of Dementia | Local report | 9  National Audit of Dementia | Local report | Key recommendations: Delirium Medical Directors and Directors of Nursing should ensure that people with dementia admitted as an emergency are assessed for delirium using a standardised tool such as the 4AT or Confusion Assessment Method (CAM) (NICE CG 103 1.2)1 and consider the symptom of pain as a contributory factor National Audit of Dementia | Local report | 10  National Audit of Dementia | Local report | 10   recorded reasons (NB: excludes patients who died or were selfdischarged) Received end of life care in hospital/was on end of life care plan 12.5% (1227) 16% (8) * National Audit of Dementia| Local Report | Appendix A      National audit Round 4: Your hospital Round 4: Your hospital Round 3: Primary diagnosis/cause of admission Respiratory 19% (1861) 22% (11) 28% (14) Fall 14.8% (1449) 18% (9) 6% (3) Urinary/renal 8.7% (849) 10% (5) 8% (4) Hip dislocation 6.4% (627) 4% (2) 10% (5) Cardiac/vascular 6.4% (628) 4% (2) 2% (1) Delirium/confusion 6.2% (604) 4% (2) 2% (1) Sepsis 6% (586) 2% (1) 4% (2) Gastrointestinal 4.5% (442) 4% (2) 8% (4) Unable to cope/frailty/social/ dementia/psychiatric behaviour 4% (398) 8% (4) 12% (6) Stroke 3.2% (316) 2% (1) 4% (2) Brain/neurological 2.4% (230) 4% (2) 6% (3) Other 2.2% (218) 0% (0) 0% (0) Skin lacerations or lesions 2.1% (202) 4% (2) 0% (0) Other fractures 1.9% (184) 4% (2) 2% (1) Pain/swelling 1.8% (177) 2% (1) 2% (1) National Audit of Dementia| Local Report | Appendix A    National audit Round 4: Your hospital Round 4: Your hospital Round 3: Impaired consciousness 1.7% (166) 0% (0) 0% (0) Endocrine or metabolic 1.5% (146) 2% (1) 0% (0) Haematology 1.5% (143) 0% (0) 2% (1) Dehydration 1.4% (134) 0% (0) 0% (0) Liver related/hepatology 0.9% (92) 0% (0) 0% (0) Cancer 0.7% (70) 2% (1) 4% (2) Not documented/unknown 0.6% (59) 0% (0) 0% (0) Rheumatic 0.5% (52) 0% (0) 0% (0) Surgical/non-surgical procedure 0.5% (50) 2% (1) 0% (0) Oral/visual 0.4% (39) 0% (0) 0% (0) Adverse reaction/allergy 0.4% (37) 2% (1) 0% (0) Injury/trauma 0.2% (15) 0% (0) 0% (0) National Audit of Dementia| Local Report | Appendix A  National audit Round 4: Your hospital Round 4: Your hospital Round 58 % (29) 36.2% (17) 0% (0) * 60% (30) 36% (18) 0% (0) 0% (0) 0% (0) * Place of residence before/after admission Before Own home After Before Respite care After Before Rehabilitation ward After Before Psychiatric ward After Before Carer’s home After Before Intermediate care After Before Residential care After Before Nursing home After Before Palliative care After Transfer to another hospital Long stay care Before After Before After 59% (5776) 42% (3648) 0.8% (74) 1.5% (134) 0.3% (31) 1.6% (135) 0.5% (46) 0.6% (51) 1.4% (138) 1.3% (114) 0.7% (73) 4.3% (373) 17.9% (1753) 19.8% (1723) 18.1% (1775) 25.8% (2241) 0% (3) 0.6% (51) 0.9% (90) 2.1% (185) 0.2% (23) 0.3% 0% (0) 8.5% (4) * 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 22% (11) 29.8% (14) 16% (8) 19.1% (9) 0% (0) 0% (0) * * 0% (0) 0% 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) * 16% (8) 24% (12) 20 (10) 28% (14) 0% (0) * * 0% (0) 0% (0) 0% National Audit of Dementia| Local Report | Appendix A No change in residence Own/carer’s home to nursing/residential care National audit Round 4: (27) 84.3% (6544) 7.7% (937) Your hospital Round 4: (0) 83.7% (36) 8.3% (4) Your hospital Round (0) 70% (35) 14% (7) National audit Round 4: Your hospital Round 4: Your hospital Round 3: 47.7% (4662) 25.8% (2523) 11.5% (1127) 6.3% (613) 3.3% (319) 2.2% (212) 1.4% (134) 0.7% (70) 0.5% (46) 0.8% (76) 3-391 11 58% (29) 28% (14) 6% (3) 4% (2) 0% (0) 4% (2) 0% (0) 0% (0) 0% (0) 0% (0) - 54 50% (25) 18% (9) 10% (5) 6% (3) 4% (2) 4% (2) 2% (1) 2% (1) 2% (1) 2% (1) -103 10 Length of stay in the hospital: 2-10 days 11-20 days 21-30 days 31-40 days 41-50 days 51-60 days 61-70 days 71-80 days 81-90 days 90 days or more Range Median National Audit of Dementia| Local Report | Appendix A Appendix B Carer Demographics - Norfolk & Norwich University Hospital National audit Round 4: Your hospital Round 4: Your hospital Round 3: 1% (46) 3.3% (154) 6% (280) 16.9% (787) 24.5% (1139) 18.9% (879) 20.1% (934) 8.2% (384) 1.2% (55) 0% (0) 0% (0) * 0% (0) 0% (0) 0% (0) * Age range 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85 years or older Prefer not to say * 25% (5) 20% (4) 30% (6) 0% (0) * 26.7% (8) 20% (6) 30% (9) 13.3% (4) 0% (0) 31.5% (1460) 67.4% (3128) 0.1% (3) 1.1% (50) 21.1% (4) 78.9% (15) 0% (0) * 16.7% (5) 83.3% (25) 0% (0) 0% (0) 87.2% (4003) 3.6% (167) 3.9% (177) 95% (19) 0% (0) 0% (0) 100% (30) 0% (0) Gender Male Female Other Prefer not to say Ethnicity White/White British Black/Black British Asian/Asian British 0% (0) National Audit of Dementia| Local Report | Appendix B Other Prefer not to say National audit Round 4: Your hospital Round 4: Your hospital Round 3: 3.1% (143) 2.2% (103) 0% (0) * 0% (0) 0% (0) National audit Round 4: Your hospital Round 4: Your hospital Round 3: 32.5% (1529) 56.3% (2649) 5.5% (261) 4.7% (221) 1% (49) 36.4% (8) 54.5% (12) * 45.2% (14) 51.6% (16) * 0% (0) 0% (0) 0% (0) 0% (0) 80% (16) 76.7% (23) Relationship to person Spouse or partner Family member Friend Professional carer (health or social care) Other One of main carers for patient Yes 76% (3268) National Audit of Dementia| Local Report | Appendix B Appendix C Staff Demographics - Norfolk & Norwich University Hospital National audit Round 4: Your hospital Round 4: Your hospital Round 3: % of patients encountered in role who have dementia/ possible dementia Up to 25% 26 - 50% 51 - 75% More than 75% 30.5% (4295) 26.7% (3764) 25% (3514) 17.8% (2502) 23.6% (26) 10.9% (12) 29.1% (32) 35.5% (39) 15.8% (16) 15.8% (16) 33.7% (34) 34.7% (35) 14.9% (2113) 83.7% (11843) 0.2% (34) 1.2% (164) 10% (11) 89.1% (98) 0% (0) * 18.8% (19) 81.2% (82) 0% (0) 0% (0) 90% (99) 80.2% (81) 7.3% (8) 6.9% (7) 0% (0) * * 10% (10) * Gender Male Female Other Prefer not to say Ethnicity White/White British 76.3% (10802) Asian/Asian British 10% (1421) Black/Black British 4.8% (684) Other 6.4% (902) 2.4% (345) Prefer not to say * National Audit of Dementia| Local Report | Appendix C National audit Round 4: Your hospital Round 4: Your hospital Round 3: Job role Registered nurse (Band or 6) Registered nurse (Band or above) 29.9% (4215) 10.9% (1542) 25.4% (3587) 9.7% (1370) 11.4% (1601) 12.7% (1784) 21.8% (24) 7.3% (8) 18.2% (20) 15.5% (17) 21.8% (24) 15.5% (17) 22.8% (23) 4% (4) 24.8% (25) 28.7% (29) 8.9% (9) 11% (11) 13.3% (1873) 86.7% (12217) 18.5% (20) 81.5% (88) 12% (12) 88% (88) 7.3% (8) 7.3% (8) 18.2% (20) 14.5% (16) 20.9% (23) 6.4% (7) 25.5% (28) 17% (17) 12% (12) 20% (20) 16% (16) 19% (19) 5% (5) 11% (11) Healthcare assistant Doctor Allied healthcare professional Other Hours worked per week Up to 29 hours 30 hours or more Time worked in the hospital Less than months - 11 months - years - years - 10 years 11 - 15 years More than 15 years 6.8% (958) 9.1% (1284) 16.4% (2307) 20.1% (2828) 14.7% (2076) 10.6% (1490) 22.4% (3150) National Audit of Dementia| Local Report | Appendix C Appendix D: Staff Suggestions   Registered Nurses (Band or 6) Having access to gardens connected to the ward in the courtyard Currently locked and only security have the keys Perhaps a bit more flexibility around the time patients are woken and given a wash Providing more staff [illegible] Sometimes the needs of dementia patients are very high also changing bed spaces all the times increases their confusion More staff for 1:1 support for challenging and distressed patients Avoid moving patients from 8pm-8am Improve on staffing, especially if patients need 1:1 for safety reasons Better training for all staff on supporting people with dementia including agency workers More activities on wards and better access to day room facilities Make day rooms more dementia friendly Extra staff at mealtimes and during day to offer snacks and support meals More staff when demand increases More volunteer work to activities with patients who have dementia Maybe everyone with dementia should have automatic referrals to the dementia support workers? More bed space Rehabilitation hospitals have beds in the space that we have More room to store own clothes, policy to be dressed when no longer acutely ill needed but needs to be supported with patients having their own clothes and family laundering them Dining tables More support at mealtimes Dementia team don't help on our ward Higher staffing levels to provide one-to-one for those patients who need it This would increase staff morale and help the patient, as well as other patients as they will be given more help from the nurse Radios/televisions on all [specialist] wards to help stimulate people with dementia Cost shouldn't be thought of first To improve the education of nurse bank 'specials' and to get a standardised way of providing care and support Try to make their visits to any department easier and quicker for people with dementia Requirement of assistance if the carer needs help More time to complete 'this is me' with patients and families, adequate staffing to support patients with increased needs and less pressure on bed flow when acuity high on ward A larger team of Dementia Specialist staff in the hospital Make it clearer at the bed space when a patient has dementia - clearer signposting More staff would be great but not always possible More training on dementia would be appreciated As a general trained nurse working in an outpatient area, I often work with patients that have been diagnosed with dementia I feel that more knowledge would help me to improve the care that I provide We are all able to access learning from journals etc and it is important that we also take responsibility for our own learning Good communication between care providers (Hospital and Primary care), more accurate description about patients with dementia to be able to meet their needs More staff is needed to support Our ward is often a quick turnover of patients so we don't always get 'this is me' paperwork completed in a timely manner by next of kin Due to business of ward I feel we don't get time needed to spend with dementia patients and staff can't gauge why patients are agitated (be if they may need commode, in pain) If staffing levels were better, they could spend more time supporting them and encouraging a better oral intake Need more training for healthcare assistants to encourage oral intake in people who have dementia, as nurses don't always have the time Only area that needs improvement is the ability to return to a patient several times to see if they will then accept intake Registered Nurses (Band or above) Dedicated dementia wards with appropriately trained staff More visual presence of dementia leads, visiting ward areas to work with staff to increase knowledge and better communication access to community records Larger dementia support team to cover longer hours Better study days regarding types of dementia, symptoms and resources Healthcare Assistants To always have full staffing Possibly by having more personal belongings around them including photos but to be fair space is limited and may be a cross infection issue Some members of staff should show more compassion to the patient who has dementia If patient is confused and trying to stand up, staff shouldn't shout at the patient for him or her to sit down Although staff should stop patronising patients and treat them as individuals Those needing 1:1 to have them To provide confidence/resilience training as mandatory Our ward is excellent and the best they can We need to stimulate patients so they are not so bored More staff, we're short staffed majority of the time, so we can't spend as much time as we like supporting those patients who have dementia More training on how to deal with wandering/agitated patients Although we have volunteers to help with keeping people occupied, it is unfortunate that there are never enough More time needed to spend with patients I feel we need more staff so more social activities can be made available for our patients Having the resources of a specialist trained health care assistant or clinical nurse to assist with dementia care on each ward would be a great asset More staffing on a regular basis Having more colleagues on all shifts Dementia friends, part of helping is learning the condition and understanding it Also, helping families understand the condition More detailed information on the person within notes - previous life experience, likes and dislikes, triggers etc More sessions with the dementia awareness teams or ability to interact with the Older People's Medicine wards A wider choice of finger foods fish fingers and chicken nuggets not always nutritional More dementia training provided Q5- we never get together to talk as a team [illegible] dementia, provide care, may see would be good idea to arrange once a month a dementia meeting with staff Q6- the ward try to arrange specials to help with patients when they need 1:1 but sometimes is not possible when not possible the patients aren't safe Snacks' are limited - biscuits Finger food menu options are not great e.g chips/chicken nuggets Staff ratio to those need assistance is week Blood taking tends to happen around mealtimes Sometimes at meal times, doctor will still disturb the patients and sometimes the patient is eating and has to stop Doctors Provide more activities for patients White boards/(laminated and pre-printed) to write the date and place (ward - hospital) where the patient is, to orientate the patient Have a dementia champion on each ward and make them known to the different teams looking after the patient Increase nurse staffing levels so they have more time to care for patients with dementia More dementia nurses More staff and volunteers are required for personal care/feeding/hydration and for keeping patients with dementia engaged with activities of their specific interest Allied Healthcare Professionals Don't move patients at night or keep moving them from ward to ward Activities co-ordinators and more dementia support workers Wider scope for dementia intensive support team Stop inappropriate stepdown/ward moves of people with dementia I have met a patient with dementia who was moved times within the two weeks he was with us I would be muddled by that point! ‘This is Me' documents to be filled out more consistently and highlighted as a useful tool to aid care and discharge planning Not trying to rush the discharge of patients with dementia because of bed shortages To avoid moving people with dementia around wards Get more patients with dementia out of bed and moving rather than being left in bed flat on their back reducing stimulation and increasing confusion More snacks available They could support the carers more Information sheet in notes on likes/dislikes, what they used to etc to help us to engage with them All staff may benefit from more training/learning in Person Centred Care Higher staffing levels to support patients fully Reduction in patients being moved wards multiple times Other Specialist training considering we are a dementia ward Providing more opportunities for patients to get away from the ward More staff would allow patients to go outside and activities away from the bed space Regular training and observing staff engaging with patients with dementia Patients should be taken outside when possible as the ward environment isn't very dementia friendly Many patients also feel frustrated to be stuck in the ward environment for long periods of time More training and experience to all staff who encounter people with Dementia Better understanding and awareness is needed, also refreshers with "real" life stories Yearly mandatory training Not moving patients during the night with dementia I think even administration on the ward needs some dementia training as I encounter people everyday - usually at my desk! Extra staff to communicate and entertain those with certain types of dementia who enjoy company and stimulation We need more staff to help us on the wards When patients from Ambulance and Emergency arrive on the ward and they have already been identified as dementia patients, to have the blue wristband on so we are able to start caring and supporting them I understand that that sort of information is given via handovers, but admin staff may not know this, and this could allow us to help communicate with the patient Carers and relatives could be more involved at meal times Make sure we read 'This is me', maybe sign once read The food needs to be improved, not enough finger foods offered and the sandwiches are very dry, the catering staff need to be trained a lot better Too many red trays and not enough mealtime staff to assist to give time and encouragement to some patients   The National Audit of Dementia (care in general hospitals) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions The programme is funded by NHS England/NHS Improvement, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies www.hqip.org.uk/national-programmes.  National Audit of Dementia | Local report | National Audit of Dementia | Local report |