Enhancing audit and feedback in acute Trust dementia care · Assessment of mental status The...
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Enhancing audit and feedback in acute Trust dementia care Michael Sykes NIHR Doctoral Research Fellow [email protected] @msykes09
Transcript of 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
[email protected] @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
[email protected] @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
