National Audit of Dementia Our Experience

1. National Audit of DementiaOur Experience Salford Royal Foundation NHS Trust Janice McGrory Neil Connor 12th February 2013

2. Overview • Brief background to dementia • Timeline for Salford Royal Foundation Trust • Where we were • Where we are now • How we got there

3. Background to Dementia Dementia is a syndrome (a group of related symptoms) that is associated with an on-going decline of the brain and its abilities. Including: • memory • thinking speed • mental agility • language • understanding • judgment

4. Background Continued • Affects about 820,000 people in the UK1 • The condition usually occurs in people aged over 65 years • Around 1 in 100 people over 65 years of age have dementia. This increases to 6 in 100 for people in their late 70s, and 20 in 100 for people in their late 80s • It is estimated that by 2021, the number of people in the UK with dementia will have increased to almost 950,0002 • Cost in the UK - £23billion per year • 2040 - 1.4 million people with a cost of £50billion3 1.Dementia UK 2.Delivering Dignity - NHS Confederation 3.Living well with dementia: - National Dementia Strategy - DH

5. Timeline for Salford Royal • First organisational audit • Mar – May 2010 • Lead Nurse for Dementia appointed • Aug 2011 • Re-audit • June 2012 • Re-measure • Jan 2013 • Interim report • Dec 2010 • Audit Lead • Feb 2012 • Interim report • Jan 2013 • Quality Improvement Collaborative • Feb 2013 2010 2013 and on

6. Compliance With National Organisational Clinical Audit 2011 & 2012 N = 136

7. Still to be achieve • Care pathway - has been piloted, amended and re-piloted • Dementia and delirium policy is being developed • Offered dementia training to our translation services partners • Dementia awareness on the clinical staff induction programme

8. Liaison teams • Governance • Care pathways • Antipsychotic drugs • Environment • Nutrition • Identification • Training • Effective discharge

9. Governance • Executive and clinical leads • Action plan

10. Governance • Identification • Executive and clinical leads • Butterfly symbol • Action plan • Patient passport • Alert email • Datix system • Letters to the GP • Recorded on EPR • 3 questions, is the patient a carer?

11. Governance • Identification • Care pathways • Executive and clinical leads • Butterfly symbol • Core care plans • Action plan • Patient passport • Alert email • Dementia assessment process on EPR • Datix system • Letters to the GP • Dementia and delirium care pathway developed and piloted • Recorded on EPR • 3 questions, is the patient a carer?

12. Governance • Identification • Care pathways • Training • Executive and clinical leads • Butterfly symbol • Core care plans • Accredited dementia training • Action plan • Patient passport • Dementia assessment process on EPR • Alert email • Dementia and Delirium care pathway developed and piloted • Three e-learning dementia modules • Datix system • Letters to the GP • Recorded on EPR • 3 questions, is the patient a carer?

13. Antipsychotic drugs • Governance • Identification • Care pathways • Training • Executive and clinical leads • Butterfly symbol • Core care plans • Accredited dementia training • New prescriptions and rationale • Action plan • Patient passport • Dementia assessment process on EPR • Three e-learning dementia modules • Alert email • Dementia and Delirium care pathway developed and piloted • GP review date • Datix system • Letters to the GP • Recorded on EPR • 3 questions, is the patient a carer?

14. Governance • Identification • Care pathways • Training • Antipsychotic drugs • Nutrition • Executive and clinical leads • Butterfly symbol • Core care plans • Accredited dementia training • New prescriptions and rationale • Family encourage to visit at meal times • Action plan • Patient passport • Dementia assessment process on EPR • Three e-learning dementia modules • GP review date • Alert email • Dementia and Delirium care pathway developed and piloted • Red tray scheme • Datix system • Letters to the GP • Recorded on EPR • 3 questions, is the patient a carer?

15. Governance • Identification • Care pathways • Training • Antipsychotic drugs • Nutrition • Environment • Executive and clinical leads • Butterfly symbol • Core care plans • Accredited dementia training • New prescriptions and rationale • Family encourage to visit at meal times • Working with Estates • Action plan • Patient passport • Dementia assessment process on EPR • Three e-learning dementia modules • GP review date • Red tray scheme • Alert email • Dementia and Delirium care pathway developed and piloted • Ward refurbished to be dementia friendly • Datix system • Letters to the GP • Dementia capital investment group • Recorded on EPR • 3 questions, is the patient a carer? • City wide collaboration

16. Governance • Identification • Care pathways • Training • Antipsychotic drugs • Nutrition • Environment • Effective discharge • Executive and clinical leads • Butterfly symbol • Core care plans • Accredited dementia training • New prescriptions and rationale • Family encourage to visit at meal times • Working with Estates • Reviewing the discharge policy • Ward refurbished to be dementia friendly • Action plan • Patient passport • Dementia assessment process on EPR • Three e-learning dementia modules • GP review date • Red tray scheme • Dementia capital investment group • Alert email • Dementia and Delirium care pathway developed and piloted • Collaboration with Age UK • City wide collaboration • Datix system • Letters to the GP • Recorded on EPR • 3 questions, is the patient a carer?

17. Liaison teams • Governance • Identification • Care pathways • Training • Antipsychotic drugs • Nutrition • Environment • Effective discharge • Reviewing the discharge policy • Executive and clinical leads • Butterfly symbol • Core care plans • Accredited dementia training • New prescriptions and rationale • Family encourage to visit at meal times • Working with Estates • Mental health liaison team • Collaboration with Age UK • Ward refurbished to be dementia friendly • Action plan • Patient passport • Dementia assessment process on EPR • Three e-learning dementia modules • GP review date • Red tray scheme • Dementia capital investment group • Alert email • Dementia and Delirium care pathway developed and piloted • Dementia support service • City wide collaboration • Datix system • Age UK • Letters to the GP • Recorded on EPR • Humphrey Booth • 3 questions, is the patient a carer?

18. The Future • Quality Improvement Collaborative • are designed to promote a “change package” • a collection of steps known to improve care • consensus driven by clinical staff • Benchmarked the case note audit • Looking forward to the re-audit

19. In a Nutshell • Engagement and ownership • Sustainability • All staff • Collaboration

20. Thank you, any questions?