Irish National Audit in Dementia (INAD-2)
The INAD-2 audit was conducted in 2019 and examined the dementia care provided within 33 acute and orthopaedic hospitals within the Republic of Ireland. A detailed report of the audit findings was launched in September 2020. This compared findings to the situation in 2013, and contains nine key recommendations. Many areas of clinical practice have improved, particularly those with a recent strong national policy focus like assessing the risk of pressure ulcers and assessing nutrition. There were less marked improvements in gathering and recording information to support person-centred care. Other practices like screening for delirium on admission have not improved.
Overall, there was significant variability between hospitals, even within the same hospital group. There were however improvements in staff training in dementia care. Approximately 1/3 of hospitals now have dementia-specific staff employed, and the same proportion have a dementia quality improvement team or working group, reflecting a desire to work together within the hospital improve dementia care.
Partner Organisations in INAD-2
INAD-2 was a partnership between the National Dementia Office and HealthCare Audit, Quality Assurance and Verification; both within the Health Service Executive (HSE). Funding for this audit was provided by the HSE Acute Operations. The INAD-2 Steering Committee was Co-Chaired by representatives from National Clinical Advisory Group Lead (NCAGL), Acute Operations and the National Dementia Office.
INAD-2 Audit Management
INAD-2 Audit Team
INAD-2 National Audit Coordinator
Dr Mairéad Bracken-Scally
HSE Healthcare Audit, Quality Assurance and Verification;
Ms. Anne Keane
Ms. Anne McDermott
Information on the INAD-2 Steering Committee is provided below.
Audit Structure
The INAD-2 was comprised of three parts, employing tools adapted from the first INAD, which were in turn adapted from the UK Audit for the Irish population;
Casenote Audit - Each participating hospital was asked to identify the records of 40 patients with a diagnosis or current history of dementia. Of these 40 case notes, 30 which met the inclusion criteria of the project were audited against a checklist of standards that relate to admission, comprehensive multi-disciplinary assessment, care planning/delivery, and discharge. This was conducted using the INAD-2 Case Note Audit Tool. This audit tool included a detailed section on psychotropic prescribing with an associated user manual.
Hospital Organisational Audit - This section of the audit looked at the structures, policies, guidelines, care processes and key staff that impact on service planning and provision for care of people with dementia within each hospital. This was conducted using the INAD-2 Hospital Organisational Audit Tool.
Environmental Audit - This checklist involved investigation of wards through observation of the environment i.e. layout/size, signage/mapping, floors, bedding, accessibility of toilets and bathing facilities, patients safety, and the promotion of patient independence, all as they relate to dementia care. This was conducted using the INAD-2 Ward Environmental Audit Tool. In some hospitals, a more detailed environmental audit was undertaken, in partnership with TrinityHaus, Trinity College Dublin, the University of Dublin.