All hospital staff should receive mandatory training in dementia awareness, according to a leading academic, after a major audit revealed continuing problems with the quality of acute care for patients with the condition.
A quarter of hospital inpatients have dementia, but the second National Audit of Dementia has revealed one in 10 hospitals in England and Wales still do not provide training about the condition to nurses or healthcare assistants.
In addition, 40% of hospitals do not provide dementia awareness training to other support staff and 41% do not include it in their staff induction programmes.
Professor Peter Crome, chair of the National Audit of Dementia Steering Group, said there was an “unwillingness” to accept that the typical hospital patient was now older, with complex health needs, rather than young and admitted for only a short period of time.
“There is a reluctance to accept that dementia should be a core element of training by management, when really it should be – just like falls prevention,” he told Nursing Times.
“All support staff should have a basic awareness of the problem with frontline staff getting a higher degree of training,” he said.
The audit, published on Friday, looked at the care structure of over 200 hospitals and the records of almost 8,000 dementia patients admitted for five days or more.
There was a “notable improvement” since the first national dementia audit in 2010-11, including a reduction in psychotropic drug prescribing.
But the new report identified a number of areas still requiring work. For example, only around a third, 36%, of hospitals had a care pathway in place for people with dementia – though a further 51% said they had one in development.
It added that managers should ensure dementia specialist nurses were “employed in line” with Royal College of Nursing guidance, which recommends at least one whole time equivalent specialist nurse for every 300 admissions for people with dementia per year.
The report also noted that assessment for delirium and mental state remained “alarmingly low”.
Around half of hospitals had a policy or guideline to ensure patients with dementia or cognitive impairment were assessed for delirium at presentation, two-thirds of case notes had no record that an assessment had been carried out.
Professor Crome said improvements were needed in the dissemination of patient information on dementia to other staff.
He said it was vital trusts introduced a personal information document section in case notes, such as the Alzheimer’s Society’s “This is Me” initiative, or adopted the “butterfly” scheme to identify patients with dementia
He also suggested changing the layout of dementia wards, which tended to be “task orientated”, in order to enable staff to “engage more” with the patients and “replicate” care at home within acute settings.
In a statement, NHS England said it remained “committed” to improving lives of those with dementia, but acknowledged there was “still work to be done”.
A spokeswoman said: “Together with the Dementia Action Alliance, we are working with a wide range of clinicians, carers and patients to achieve this.”
The alliance, which is hosted by the Alzheimer’s Society, is made up of over 480 UK organisations committed to improving dementia care.
Alzheimer’s Society head of policy George McNamara said it was “scandalous” dementia care was not “top priority” for hospitals.
“We know that staff want to improve their knowledge of dementia care, but they need to be offered the right tools, support and training to do so,” he said.
RCN chief executive and general secretary Peter Carter added: “This report makes it clear that more needs to be done to improve training and dementia awareness.
“However, training and awareness alone are not enough and we fully support the recommendation in this report that specialist dementia nurses should be employed in all hospitals.
“A recent RCN report found that specialist dementia nurses can reduce the length of hospital stays, prevent readmissions and provide education and leadership for other staff,” he said. “Dementia specialist nurses should be a top priority.”
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