Previous Audits of Dementia Care
First Irish National Audit of Dementia in Acute Hospitals (INAD)
The full report and executive summary report of the Irish National Audit of Dementia (INAD), published in 2014, can be accessed below. The (INAD) was comprised of four parts, employing tools adapted from the 2010 UK Audit for the Irish population;
Casenote Audit - Each participating hospital is asked to identify the records of 30 patients with a diagnosis or current history of dementia. Of these 30 case notes, 20 which meet the inclusion criteria of the project are audited against a checklist of standards that relate to admission, comprehensive multi-disciplinary assessment, care planning/delivery, and discharge.
Hospital Organisational Audit - This section of the audit looks 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 general hospital.
Ward Organisational Audit - The purpose of this tool is to investigate; staffing levels and practices, ward access to services, information availability and provision to dementia patients and carers/relatives, as well as nutrition and communication. The ward organisational audits are carried out on at least one surgical and one medical ward in each participating hospital.
Ward Environmental Checklist - This checklist involves 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.
Below are PDF files of the tools employed to carry out the first INAD. The tools below have been modified for use in the Irish population with the full permission of the original authors, the Healthcare Quality and Improvement Partnership (HQIP). The tools below must not be reproduced, distributed, modified or used without permission from HQIP.
The first INAD was a joint initiative between:
- The Centre for Gerontology and Rehabilitation, University College Cork (Dr. Suzanne Timmons and Dr. Paul Gallagher): The Centre for Gerontology and Rehabilitation- ucc.ie
- The Centre for Ageing, Neuroscience and the Humanities- ageandknowledge.ie
- Trinity Centre for Health Sciences, Tallaght Hospital Dublin (Prof. Des O’Neill and Dr. Sean Kennelly): Trinity Centre for Health Sciences- tcd.ie
- HSE Quality and Patient Safety Directorate (Ms. Denise McArdle)- hse.ie
Funding for this national audit of dementia care was given by Atlantic Philanthropies- athlanticphilanthropies.org and the Meath Foundation- meathfoundation.com.
INAD Partners
Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital; Professor Des O’Neill, FRCP Consultant Physician in Geriatric & Stroke Medicine & Professor in Medical Gerontology, Tallaght Hospital & Trinity College Dublin/ Dr. Sean Kennelly, Consultant Physician in Geriatric and Internal Medicine, Adelaide and Meath Hospital, Tallaght, Clinical Senior Lecturer in Medical Gerontology, Trinity College Dublin.
Centre for Gerontology and Rehabilitation, University College Cork; Dr. Suzanne Timmons, Senior Lecturer, Centre for Gerontology and Rehabilitation, School of Medicine, UCC/ Dr. Paul Gallagher, Consultant Physician in Geriatric Medicine, Cork University Hospital & St. Finbarr's Hospital, Senior Lecturer, School of Medicine, UCC.
Quality and Patient Safety Directorate (QPS); Edwina Dunne, Director QPS
Northern Ireland Audit of Dementia
There are approximately 20,000 individuals living with dementia in NI currently, and with this figure set to increase to 60,000 by the year 2051, it is urgent that improvements be made to services providing dementia care.
The Department of Health, Social Services and Public Safety in Northern Ireland (DHSSPS) have published a strategy on dementia services in order to make such improvements, ‘Improving Dementia Services in Northern Ireland - A Regional Strategy’, (Consultation on Improving Dementia Services in Northern Ireland, 2010), with a section focused on the importance of improving acute hospital care.
This is a particularly important area for development given the evidence to suggest that hospital admission is distressing and disorientating for a person with dementia, and is associated with a decline in their cognitive ability and functioning.
The first Northern Ireland Audit of Dementia Care in Acute Hospitals (NIAD) was carried out in order to obtain a baseline picture of the quality of care from admission through discharge. The following questions will drive the audit:
- What structures and resources do hospitals have in place to enable them to identify and meet the care needs of patients with dementia?
- What evidence can be assembled to demonstrate that hospitalised patients with dementia receive an acceptable level of care?
Recommendations from this NIAD aimed to enable the implementation of the strategy on dementia services in acute hospitals.
All 12 acute hospitals in Northern Ireland were audited as follows, based on the recent audits carried out in England & Wales (2010; 2012), as well as in the Republic of Ireland (INAD, 2014).
1) hospital organisational audit: policies at hospital and trust level (2-3 senior managers/clinicians);
2) ward organisation audit: resources on the ground (2-3 wards per hospital);
3) ward environment audit: built environment/layout (2-3 wards per hospital);
4) patient case-note audit: actual practice (20 per hospital).
The second round of audit in England & Wales brought about significant improvements in the quality of care being delivered to people with dementia in acute hospitals.
It is our vision that this baseline audit in Northern Ireland will similarly drive improvements in care, in line with the dementia strategy.
The results of this audit were published in 2015.
The Northern Ireland Audit of Dementia Care in Acute Hospitals (NIAD) was led by The Centre for Gerontology and Rehabilitation, University College Cork (Dr. Suzanne Timmons, Consultant Geriatrician, Senior Lecturer), and co-lead by Ms Eleanor Ross, Nurse Consultant & Mr. Seamus McErlean, Commissioning Lead for Older People and Adult Services, HSBC, both leads of the Dementia Strategy Implementation Group.
Funding for this national audit of dementia care was very generously given by Atlantic Philanthropies.
Details of the NIAD audit team, Steering Group and Advisory Committee members can be found on ucc.ie
NIAD Audit Team
Emma O’ Shea, Research Support Officer, Centre for Gerontology & Rehabilitation, UCC
Edmund Manning, Clinical Research Nurse, Centre for Gerontology & Rehabilitation, UCC
The final report of the Northern Ireland Audit of Dementia Care in Acute Hospitals can be accessed below.