What is the Irish National Audit of Dementia?
National and international research confirms that an admission to an acute hospital can be distressing and disorientating for a person with dementia, and is often associated with a decline in their cognitive ability and levels of functioning around activities of daily living. In response to the need for more Irish data on dementia care in acute hospitals, the first Irish National Audit of Dementia Care in Acute Hospitals (INAD) was undertaken in 2013 to measure criteria relating to care delivery known to impact on people with dementia admitted to hospital. The report of the first Irish National Audit of Demetia Care in Acute Hospitals (INAD) was published in January 2014. The audit, kindly funded by Atlantic Philanthropies and The Meath Foundation, was carried out in all 35 acute public hospitals that admit adults with known/suspected dementia. Relevant parameters included policies and governance within the hospital that recognise and support the needs of people with dementia, elements of comprehensive assessment, involvement of carers, discharge planning, and identified changes to support needs during admission. INAD was based on the UK National Audit of Dementia (2011) in acute hospitals which found many deficits in practice. Our aim was to, with permission, replicate the UK audit, using minor modifications for the Irish setting.
A second audit (INAD-2) was completed in 2019 in 33 acute and orthopaedic hospitals in the Republic of Ireland. This audit aimed to provide an overview of dementia care in acute hospitals. Findings were compared with the findings of INAD from 2013 in order to inform local and national education plans, staffing and resource allocation. The audit had three parts:
- Hospital organisational audit (interview with senior hospital staff about hospital policies and procedures)
- Environmental audit (observation of the structural environment within a number of areas in the hospital)
- Case note audit (examining the care received by people with dementia through an audit of case notes)
The Poster for INAD-2 and Information Sheet for INAD-2 are available to download.
Why is INAD important?
Currently there are approximately 55,000 people with dementia in Ireland. By 2036 however, it is estimated that this figure will rise to 115,000. The Department of Health published the Irish National Dementia Strategy in 2014. The Strategy sets out a number of principles to underpin the provision of care and supports for people with dementia including:
- taking account of dementia in the development and implementation of existing and future health policies;
- encouraging the participation of people with dementia in society and in their own communities as fully as possible for as long as possible;
- the prioritisation of end-of-life care in an appropriate setting for those with dementia;
- appropriate training and supervision for all those caring for or providing services to people with dementia;
- directing resources to provide the best possible outcome for those with dementia, and for their families and carers.
The Irish National Dementia Strategy (Department of Health, 2014) aims to increase awareness, ensure early diagnosis and intervention and enhance services for people living with dementia. The National Dementia Office (NDO) was established in 2015 in accordance with the launch of the National Dementia Strategy. The NDO provides leadership at a system level for the implementation of the strategy. Its role and function is to oversee the implementation, monitoring, and ongoing evaluation of the National Dementia Strategy.
In the UK, the second round follow up of the National Audit demonstrated that the publication of the first round audit results had led to significant improvements in the quality of care received by patients (Royal College of Psychiatrists, 2013). Through examination of the data which will be collected through INAD-2 and comparison with findings of the first INAD, the level of penetration of the National Dementia Strategy can be better understood and the level of change in the quality of care received by people with dementia when admitted to hospitals in Ireland can be investigated. The INAD-2 was included in the HSE Quality Assurance and Verification healthcare audit plan for 2018/2019, so is an important priority for the HSE.
If the quality of hospital care for patients with dementia can be improved in Ireland, this will lead to a decrease in the overall cost of dementia care, reduced staff burden, and importantly, more positive health outcomes for patients with dementia.