Full report of the Irish National Audit of Dementia
Please click here INAD FULL REPORT 2014 to download the full report of the Irish National Audit of Dementia.
Download the Executive Summary
Audit Tools from INAD 2014
The Irish National Audit of Dementia (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.
Partner Organisations in INAD 2014
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 Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital Dublin (Prof. Des O’Neill and Dr. Sean Kennelly) and the HSE Quality and Patient Safety Directorate (Ms. Denise McArdle).
Funding for this national audit of dementia care was given by Atlantic Philanthropies and the Meath Foundation.
Audit Management for INAD 2014
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
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.
Partner Organisations & Audit Management
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.
NIAD Steering Group members and Advisory Committee members
NIAD Audit Team
Emma O’ Shea, Research Support Officer, Centre for Gerontology & Rehabilitation, UCC
+353 87 755 1275
+353 85 788 9499
Edmund Manning, Clinical Research Nurse, Centre for Gerontology & Rehabilitation, UCC
Report of the Northern Ireland Audit of Dementia
Link to the final report of the Northern Ireland Audit of Dementia Care in Acute Hospitals: Report NIAD
Conference 2014: Dementia Care in Acute Hospital Settings
National Conference on Dementia Care in Acute Hospitals
Over 170 delegates from a wide range of disciplines attended the first National Conference on Dementia Care in Acute Hospitals in University College Cork on Friday 31st January 2014. The conference, which was opened by Ms Kathleen Lynch, Minister for Disability, Older People, Equality & Mental Health, included speakers from a wide range of backgrounds, including Gerontology, Psychiatry of Old Age, Nursing, Social Work, General Practice and the HSE. This ensured that a broad spectrum of perspectives on the experience and issues of caring for older people with dementia during an acute hospital admission were presented throughout the day.
An expert panel discussion, chaired by Professor Des O’Neill, ensured that delegates could explore issues most pertinent to them and facilitated information sharing and discussion. Questions and answers throughout the day continued to generate discussion around each of the subjects presented.
Topics discussed on the day included community perspectives on acute hospital care, aspects of the National Dementia Strategy, the economic case for better dementia care in acute hospitals, and emerging data from the Dementia in Acute Cork Hospitals Study (ODCACS). Two breakout sessions in the afternoon gave delegates the choice to attend lectures focused on ‘challenging behaviour and delirium’ or ‘towards better care’. These sessions included presentations on the acute hospital environment, the National Dementia Education Programme and perspectives on end of life and palliative care.
The conference also saw the official launch of the results of the first Irish National Audit of Dementia care in Acute Hospitals, which found that Ireland does not yet have standardised care for people with dementia in acute hospitals. The audit also showed differences in the access to dementia-relevant services between hospitals, with poor access to many diagnostic and support services. The results highlighted inadequate assessment of cognition, delirium, mood, and behavioural and psychological symptoms in people with dementia during their admission, and where assessed and discovered, issues were not highlighted on discharge. Media coverage of the report can be found at https://storify.com/UCC_Ireland/national-dementia-audit-in-acute-hospitals-shows
Dr Kevin Stewart shared learning from the UK experience of conducting national audits, including the second round of the National Dementia Audit. This presentation gave insight into the challenges of translating research and audit findings into practical change and improvement in service delivery and structure.
Overall the day was a great success and provided a rich learning experience for all those attending. The argument for developing appropriate and responsive dementia care in all acute hospitals in Ireland was clearly and eloquently presented, along with a number of practical steps necessary to achieving this goal.
Download the conference presentations below
Conference Announcement - Dementia Care in Acute Hospital Settings
The Centre for Gerontology and Rehabilitation, University College Cork, in conjunction with our partners, was proud to host the inaugural National Conference on Dementia Care in Acute Hospitals, which took place on Friday January 31st 2014, from 9.30am to 4.15pm, in U.C.C.
This one-day interdisciplinary conference was opened by Minister for Disability, Older People, Equality & Mental Health, Kathleen Lynch, T.D, in the Western Gateway Building.
The Conference Programme boasted speakers from a wide range of backgrounds including Gerontology, Psychiatry and Psychiatry of Old Age, Nursing, Occupational Therapy, General Practice and the HSE. The event provides a forum for the most cutting-edge developments in research and practice relating to dementia care in hospital settings to be disseminated and discussed.
Some highlights of the conference included an expert panel discussion, chaired by Professor Des O’ Neill, focusing on the issues surrounding best care for people with dementia in acute hospitals, and an afternoon breakout session for delegates with a special interest in the area of delirium in the acute hospital setting.
Topics included the National Dementia Strategy, GP/community perspectives, the economic perspective, challenging behaviour, delirium, the hospital environment, education, and end of life and palliative care, all as they relate to dementia care in acute hospitals.
This event also hosted the official launch of the results of the first-ever ‘Irish National Audit of Dementia Care in Acute Hospitals’ (INAD), a collaboration between UCC, TCD and the HSE Quality and Patient Safety Directorate.
RCPI approval for 6 external CPD credits.
An Bord Altranais Category 1 approval for 5 CEUs (credits).
Click here to browse some of the photos from the conference.