Enhancing audit and feedback in acute Trust dementia care · Assessment of mental status The...

Enhancing audit and feedback in acute

Trust dementia care

Michael Sykes

NIHR Doctoral Research Fellow

Michael.sykes@ncl.ac.uk @msykes09

The realityAssessment of mental status

Assessment of delirium

Identify:

• Factors that cause distress

• Actions to calm person if agitated

Enhancing audit and feedback in acute Trust dementia care

Best practice 1

1 Royal College of Psychiatry standards derived from NICE Quality Standards, the Dementia Friendly Hospitals Charter and reportsfrom the

Alzheimer’s Society, Age Concern and Royal Colleges

The problem?

Enhancing audit and feedback in acute Trust dementia care

Audit and feedback:

Audit and feedback (A&F) involves providing a recipient with a

summary of their performance over a specified period of time

Effective: 4.3% absolute improvement

…but variable: IQR = 0.5% to 16% (Ivers et al, 2012)

Enhancing audit and feedback in acute Trust dementia care

Co-production

Implementation Evaluation

1. Describing A&F

practices in dementia

2. Development of

enhancements to A&F

and implementation

strategy

3. Feasibility test and

subsequent

refinement

Enhancing audit and feedback in acute Trust dementia care

Co-production

1. Describing A&F

practices in dementia

Enhancing audit and feedback in acute Trust dementia care

Phase 1 - Description

Enhancing audit and feedback in acute Trust dementia care

• 32 semi-structured interviews

• 36 observations

• 39 documents analysed

• Framework analysis

• Iterative presentation to co-production group for challenge and synthesis

The journey to the intervention

‘Types’ of

audit

Intervention

1) ‘Mandated’ national

2) Other national / regional• Assoc with financial incentive

3) Trust leadership• Theme

• Ward quality assurance

• Performance data

4) Clinical team

5) Individual

What the co-production

group reports

The journey to the intervention

‘Types’ of

audit

Intervention

What the co-production

group reports

1) ‘Mandated’ national

2) Other national / regional• Assoc with financial incentive

3) Trust leadership• Theme

• Ward quality assurance

• Performance data

4) Clinical team

5) Individual

The journey to the intervention

‘Types’ of

audit Audit ‘stages’

Intervention

What the co-production

group reports

Impetus

Topic

Method

Agree

Prepare

Assess

Analysis

Action plan

Feedback

Changes

The journey to the intervention

‘Types’ of

audit Audit ‘stages’

Intervention

What the co-production

group reports

Impetus

Topic

Method

Agree

Prepare

Assess

Analysis

Action plan

Feedback

Changes

The journey to the intervention

‘Types’ of

audit

Select & specify

enhancements

Audit ‘stages’

Intervention

Implementation

strategy

What the co-production

group reports

Co-production

1. Describing A&F

practices in dementia

Enhancing audit and feedback in acute Trust dementia care

2. Development of

enhancements to A&F

and implementation

strategy

Enhancements (Colquhoun et al, 2017)

(discussing specification & implementation):

1. From national priorities to ‘low baseline’

2. Support committee sense-making:

• Target message to recipient & local priorities

• Address trust and credibility

• Present comparison (national, self, peer (Gude et al, 2019))

• Present loss-framed data (e.g. 40% patients did NOT get…)

3. Link actions to results:

• Identify the barriers to target care behaviour

• Model the link between barrier and action

4. Adapt existing actions

Enhancing audit and feedback in acute Trust dementia care

Implementation strategy

Informed by Normalisation Process Theory (May & Finch, 2009)

Enhancing audit and feedback in acute Trust dementia care – Exploring feasibility (draft)

Research question Data collection Data analysis

Outcome

Documentary analysis

(Current & previous final

action plans)

Qualitative

Fidelity of enhancementStructured observation

(Specialty & Trust

governance group)

Appropriateness of enhancements

Acceptability of enhancements

Feasibility of enhancementSemi-structured interview

(Gov. group attendees)Modification of enhancement

Appropriateness of enhancements

Acceptability of impl. strategy

Feasibility of impl. strategy

Contextual influences on intervention

Semi-structured interviews

(Impl strategy recipients)

Quantitative

Cost analysis

Assessment of:

specificity; clarity;

targeting poor

performance; &

whether addressing

barriers

Cost of enhancement

Documentary analysis

Thanks to:Supervisory team

Co-production group members

Advisory group members

Michael.sykes@ncl.ac.uk @msykes09

This report is independent research arising from a Doctoral Research Fellowship, Michael

Sykes, DRF-2016-09-028 supported by the National Institute for Health Research. The

views expressed in this presentation are those of the author(s) and not necessarily those of

the NHS, the National Institute for Health Research or the Department of Health.

Enhancing audit and feedback in acute Trust dementia care