Clinical Quality Review Forum
Report to: / Clinical Quality Review Form / Agenda item:Date of Meeting:
Title of Report: / Dementia Carers Survey Update
Status of report:
(decision and approval, position statement, information, confidential discussion) / Position Statement
Lead Executive Director: / Michelle Clarke Director of Nursing and Quality
Author: / Viki Marshall, Quality and Safety Information Co-ordinator
Appendices: / 1
1. Purpose of the report
In line with the CQUIN requirements for the Dementia Carers Survey, this report provides results from April 2014 to February 2015 of the Dementia Carers Survey.
2. Recommendations
The CQRF are asked to note the content of this report in relation to the Dementia Carers Survey.
3. Summary of Key Issues for discussion
· Results of the short surveys
· Results of the extended surveys
4. Reference to previous reports
None.
5. For further information or any enquires relating to this report please contact:
Viki Marshall, Quality and Safety Information Co-ordinator, 01432 355444 ext. 5820
6. Please confirm, by ticking the box, that you have included or considered the following items in developing your report:
Background
Care Quality Commission Implications
Legal / NHS Constitution considerations
Analysis of Risk including link to the Board Assurance Framework and Risk Register
Resource Implications (staffing & financial)
Adult and Child Safeguarding
Patient, Public and Stakeholder involvement
1. Introduction
The CQUIN payment framework enables commissioners to reward excellence, by linking a proportion of English healthcare providers’ income to the achievement of national and local quality improvement goals. The key aim of the Commissioning for Quality and Innovation (CQUIN) framework is to secure improvements in quality of services and better outcomes for patients, whilst also maintaining strong organisational financial stability. A proportion of this value is linked to the national CQUIN targets and the rest is ascribed to local CQUIN indicators.
As part of the national CQUIN targets for 2014/15 Wye Valley NHS Trust (WVNHST) are to ensure carers of people with dementia feel adequately supported. WVNSHT must undertake a monthly survey of carers of people with a confirmed diagnosis of dementia. The content of this survey is for local determination has been agreed with the CCG and includes a question on whether carers of people with dementia feel adequately supported.
This report provides an overview of the results gathered from surveys undertaken by carers from April 2014 to February 2015. Due to the timescales for creating this report, no March 2015 feedback has yet been received.
2. Main Body of the Report
2.1 Methodology and Reporting
The Quality and Safety Department receives a daily update from the Information Department in relation to all patients within the hospital with a confirmed diagnosis of dementia/Alzheimer’s. Using this data a member of the Quality and Safety Department checks if the patient is eligible by checking to see where the patient lives, as only Herefordshire patients are eligible, also patients who have passed away are excluded. From January 2015 the process for collecting feedback changed. The current process ensures that once a patient is discharged from hospital a paper short survey is posted out the carer using their contact details on PAS. If the carers details aren’t listed then the short survey is sent to the carer care of the patients address.
Response rates and results are shared with Heads of Nursing, Dementia Group and with the Trust Board.
2.2 Findings
2.2.1 Number of Eligible Patients Admitted to County Hospital
Month / No. of patients / No. of eligible patients*April / 22 / 18
May / 27 / 16
June / 30 / 22
July / 34 / 19
August / 29 / 17
September / 38 / 19
October / 32 / 22
November / 45 / 25
December / 44 / 25
January / 31 / 18
February / 28 / 20
* Carers of patients that have died or live outside of Herefordshire or don’t have a Herefordshire GP are not contacted.
2.2.2 Returned Short Form Surveys
Month / No. of eligible patients / Percentage of Carers contacted / Total no. of completed short surveys / Percentage of Total CompletedApril / 18 / 100% / 12 / 67%
May / 16 / 100% / 9 / 56%
June / 22 / 100% / 11 / 50%
July / 19 / 100% / 14 / 74%
August / 17 / 100% / 12 / 71%
September / 19 / 100% / 11 / 58%
October / 22 / 100% / 12 / 55%
November / 25 / 100% / 8 / 32%
December / 25 / 100% / 15 / 60%
January / 18 / 100% / 8 / 44%
February / 20 / 95%* / 6 / 30%
*One patient is still an inpatient and therefore their carer hasn’t been contacted.
A total of 118 carers have completed the short form surveys.
2.2.3 Results from the Short Form Surveys
The response answers for the 2014/15 short survey changed; it was agreed that a yes or no answer did not provide enough learning, therefore the answers the carer can choose from have changed to;
· Strongly agree
· Agree
· Neither agree or disagree
· Disagree
· Strongly disagree
In addition to the original 4 questions, 2 additional questions have been added. This includes the Friend and Family Test question and a question of “could we have done anything better?”
The responses to all the questions asked are depicted below in relation to our performance as an organisation;
54 carers took the opportunity to answer the Friends and Family Test question, 39 carers said that they would recommend Wye Valley NHS Trust.
84 (71%) of the carers questioned felt that the patient was looked after adequately whilst in hospital.
76 (64%) of the carers questioned felt that the patients’ needs were met during their stay.
60 (51%) of the carers questioned felt that they were supported as a carer.
68 (58%) of the carers questioned felt that their views were taken into account.
Carers were asked if there was anything we could have done better. The majority of feedback has highlighted the following issues;
Even though the majority of carers felt the patient and themselves were looked after well whilst in hospital, the issue of communication appears to be an issue. This will be addressed in the actions for next years survey.
Full comments from the carers can be found in Appendix 1.
2.2.4 Extended Survey Results
All carers are given the option to complete an extended survey to provide more feedback.
Thirty-seven carers requested the extended survey, seventeen extended surveys have been returned. N.B One carer returned a blank survey and another carer completed 2 surveys for each hospital the patient stayed in.
Analysis of the questions asked can be found below;
The graph shows that the majority of carers were not given information from staff.
Examples of carers comments;
· Not much from hospital. I am looking for courses.
· After the 2 visits to Hereford and the subsequent phone call to inform me that she was to be returned to Pencombe Hall, I was so incensed that I really wanted to complain about the cold and insensitive treatment we both received - a lot of staff but no caring attitude.
· Twice doctors at Kington Surgery have done a quick memory test. They confirmed a lack of short term memory. They did not specify dementia, but it was implied.
· Since first being admitted to the Stonebow Unit in 2009, my husband has been under the DMHOP - I have information from this department.
· I have been given information by the local carers organisation.
· Patient diagnosis was made by doctor. We have had good communication and support from social worker and CPN.
· January 2015 mum beee diagnosed by memory clinic with milus mixed dementia. Mum needs supervision most of the day/night.
· I have provided information about my father's particular dementia because I know him best. The staff on all wards he was admitted too listened and acted on this information.
· All service users that are admitted to hospital come with a hospital passport and usually a carer.
This graph shows that the majority of the carers who responded were happy with the care received.
Carers comments;
· Lots of staff but long wait in A&E.
· No communication, uncaring nursing staff who did not appear to understand the needs of difficult dementia patients. On my first visit after the op, I finally got a nurse to stand still long enough to ask if my mother shaking uncontrollably was a result of anaesthetic (she was cold and next to wide open window). I was told that she had been like it all day - "I give her a blanket but she won’t keep it on". The blanket had been pressing on the tubes attached.
· Mum needed a CT scan following several falls in her nursing home. She was admitted to A + E rather than a ward and had a 10 hour wait there before being admitted to a ward. She was not seen by a doctor once during this time. Once on the ward she was moved once and then moved to a different ward. This is too confusing for a patient with Dementia.
· My husband returned home with very sore areas of skin on tops of legs and cracked sore areas in groins. If he had been left to wash himself this could be caused - he cannot be relied on to do this properly and would not ask for help.
· Staff very professional however not enough of them
· Far more involvement at Leominster Hospital where there seemed to be lack of interest in everything I said. Staff were conspicuous by their absence.
· Lack of communication. They kept saying mum was coming home every time I rang but in the end they kept her in overnight.
· Our lady was admitted several times into hospital but the last occasion was very poor, we supply a carer most of the time and we supply all the information on this person on how to care for her, any communication needs, dietary needs, medication needs etc. Also a hospital passport is supplied but like I day 9 out 10 a carer will be there everyday. WE were appalled that medication was stopped without any discussion with myself or the carer, also she returned with home with a catheter that was supposed have been taken out before she returned home and when we telephoned to find out why the catheter was in we were passed around and then finally got told that she wasn’t supposed to have it still in. Also she was prescribed antibiotics that never came with her they went to another hospital.
This graph shows that the majority of the carers who responded were happy with the patient’s safety during their stay.
Carers comments;
· Plenty of staff.
· The way I was informed that my mother was to be returned to Pencombe Hall was so cold and clinical, I genuinely thought I was being informed that she had died, surely the words "There’s nothing to worry about, I am just ringing to tell you ….." would be a good idea. I am afraid that I actually asked the person if any staff had dementia training!
· Staff very professional however not enough of them
· With staff shortage, patients sometimes get out of bed and wander (if able) for the toilet etc. - relation to dementia patients.
· On the small room wards, staff could not monitor the patients easily. My father was able to get up and into the corridor while still attached to a catheter. The Nightingale style wards enable staff to see everyone at all times. Fellow patients monitor as well.
· If this person was returning to her own home she would have been at risk as due to the above comments.
This graph shows that the majority of the carers who responded were happy with the communication the patient had with staff.
Carers comments;
· Being slightly deaf, my wife had difficulty in understanding what was going on.
· Mum could not understand where she was or why she was there.
· This is usually good - staff are lovely but sometimes unaware of how bad dementia is. My mum understood at time but could not remember what they said - I had to ask all the time.
· Listening to the patients carer. These are the people who know what is happening. Each case of dementia is unique.
· I am very impressed with the way staff engaed (or tried too) with patients. Always with respect, care (and sometimes a sense of humour if appropriate!).
This graph shows that the carers had mixed comments with the communication they received from staff members.
Carers comments;
· I had to ask.. I am her attorney.
· We had to ask for information at all times. Information was very slow at being given and some of it was conflicting.
· Not given any information re my husbands condition. I have to manage his medication - changes were made and no info for me. After his return home - received two outpatient appts - no idea why or who initiated them.
· Difficult to get info re medication. Did not encounter centre manager until discharge was being arranged. This was full of confusion and I felt her attitude to me was quite hostile and unsympathetic . Met GP at the centre just prior to discharge and he was helpful to me.
· Was okay when I asked. I did feel sometimes that I was being a pest :).
· Considering we had a staff member present most of the time, if for some reason someone couldn’t be there, we would ring but the communication was poor or I would ask why something was being done and they didn’t know.