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.
Irish National Audit of Dementia Care (INAD-2)
Please find video recordings from the launch below:
1: Dr. Vida Hamiliton: Acute Hospital Dementia Care had never been more important
2: Dr. Suzanne Timmons: Key Findings and Recommendations from the INAD-2 Audit
3: Prof. Stephen Byrne: INAD-2 Psychotropic Medication Spotlight Audit (Pre-Implementation of a National Clinical Guideline)
4: Kevin Quaid & Maire Anne Doyle: Why good Acute Hospital Care makes a difference to a Person Living with Dementia
5: Tom Grey: Towards "Dementia Friendly Hospitals" using Universal Design- Environmental Audit
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
INAD-2 Steering Committee
The INAD-2 Steering Committee provided governance, guidance and direction in order to attain the objectives of the project. The Steering Committee was Co-Chaired by Dr Suzanne Timmons, National Dementia Office, and Dr Vida Hamilton, HSE Acute Operations
National Dementia Office; Dr Suzanne Timmons, Co-Chair of Steering Committee and Clinical Lead of National Dementia Office
HSE Acute Operations; Dr Vida Hamilton, Co-Chair of Steering Committee and NCAGL, Acute Operations
Healthcare Audit - Quality Assurance and Verification; Ms Anne Keane/Ms Anne McDermott, Auditors, Healthcare Audit, Quality Assurance and Verification and Ms Cora McCaughan, Assistant National Director, Healthcare Audit, Quality Assurance and Verification
INAD-2 Audit Team; Dr Mairéad Bracken-Scally, National Audit Coordinator for INAD-2
Dementia Environment Project, TrinityHaus; Prof Desmond O'Neill, Professor in Medical Gerontology, Trinity College Dublin
Irish Society of Physicians in Geriatric Medicine; Dr Paul Gallagher, Consultant Geriatrician and Senior Lecturer, University College Cork
National Clinical Care Programme for Older People; Dr Sean Kennelly, Co-Investigator, Dementia Inclusive Hospital Design Audit Tool and Consultant Geriatrician
Ms Emma O'Shea, Former Project Manager of Northern Ireland Audit of Dementia
Nursing and Midwifery Directorate; Ms Leonie Finnegan/Ms Michelle Quinn, NMPDU Quality Care Metrics Project Officers
Office Nursing Midwifery Services Director; Ms Deirdre Lang, Director of Nursing/National Lead Older Persons Services, Clinical and Integrated Programmes
Irish Association of Consultants in Psychiatry of Old Age; Dr Sabina Fahy, Consultant Old Age Psychiatrist
Alzheimer Society of Ireland; Ms Catherine O'Keeffe, QPSD Manager
Health Information and Quality Authority; Ms Geraldine Ryan, Regional Manager
Dementia Services Information and Development Centre; Mr. Matthew Gibb, Director, DSiDC
Dublin City University; Prof Kate Irving, Professor of Clinical Nursing
School of Epidemiology and Public Health, UCC; Prof. John Browne, Director of the National Health Services Research Institute in Ireland
National Clinical Programme Neurology; Dr Siobhán Hutchinson, Consultant Neurologist, St James's Hospital
HSE Quality Improvement Team; Ms Nicola O'Grady, HSE Quality Improvement Team
HSE Health and Social Care Professionals Office; Ms Joan Elliott, OT Manager, Naas General Hospital
Emergency Medicine Programme; Dr Rosa McNamara, Emergency Medicine Consultant
HBS Estates, HSE; Mr Derek Dockrell, Architectural Advisor
National Clinical Programme Neurology; Dr Seán O'Dowd/Mr Emmett Kelly, Consultant Neurologist/CNM Neurology, Tallaght University Hospital
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.
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.