Audit of Carer and Contacts documentation
for Patients with Dementia
Dr Jenny Finlayson, Banchory Medical Group 2014
Introduction
Carers have a significant role to play in assisting dementia sufferers to manage at home, and
can enable patients to remain in their own homes for longer. They have a key role as main
contact and organiser for day-to day activities, appointments, medication etc, as well as
offering emotional support and companionship . Many carers are partners or close relatives
of the dementia sufferer and over time their input often increases. It can be a very
challenging role and carers can sometimes feel isolated and unsupported. It is important to
recognise the carers and support them, as well as having up-to-date contact information so
contact can be easily co-ordinated.
Recording of contact details for patients with carers / patients who are carers within the
practice (Total = 30)
Patients with contacts correctly listed / notes linked = 14 (46.6%)
Patients with contacts incorrectly listed / on yellow sticky / incomplete = 5 (16.7%)
Patients who have carers but details not documented = 11 (36.7%)
Patients with
contacts listed
correctly
Patients with
contacts listed
incorrectly
Patients with
contacts not listed
Identified as one of the eight Common Core Principles of Dementia (1), we should strive to
ensure ‘Family members and other carers are valued, respected and supported, just like
those they care for and are helped to gain access to dementia care advice’.
Accurate and appropriate documentation of relevant information in GP notes, and where
appropriate, Emergency Care Summary (ECS), can assist day-to-day management, both inand out-of-hours, and enable the most appropriate management plans in both emergency
and non-emergency situations. Anticipatory Care Plans (ACPs) also have a role to play in
more complex cases.
Emergency Care Summary (ECS) Documentation
15 patients had Anticipatory Care Plans (ACPs).
There were 2 patients with ACPs who did not have KIS consent.
One patient had a DNACPR documented (no ACP), however no KIS consent was recorded.
Aims
To audit all patients coded as having a dementia diagnosis, and who are living at home, to
identify how carers are coded, both in patients’ and carers’ notes. Also to analyse how carer
contacts are recorded in the notes, and whether relevant information is readily accessible,
both in-hours, and if required, out-of-hours.
Method
A search was run for all patients coded as having a diagnosis of dementia, and a further
search run for a sub-group living at home (ie. not in nursing / residential home or
supported accommodation). A search was also run for these patients to identify who
was coded as having a carer.
Results showed an under-recording of dementia patients with carers, and a variation in how
these were coded.
There was a significantly higher under-recording of patients who were carers, and again some
variation in how these were coded.
There were variable sites in the notes that contact details were recorded, with subsequent
reduction in linking of patients notes (carer / dementia patient), as well as some missing
carer data in ECS information.
The absence of KIS consent in some notes meant that details / ACPs recorded by the GP for
Out-of-Hours information was unavailable to the Out-of-Hours service.
Each set of notes was then analysed for :1. Coding of carer – what priority of coding was used
2. Recording of contacts for patient – was it in the correct contacts site ( notes therefore
linked)
3. If no carer was coded, GP notes, dementia reviews and psychiatry letters were
checked to identify if there was a carer but not documented
4. Partners / carers notes were checked to see if they were coded as being a carer
5. ECS details checked for both patients are carers to ensure KIS (Key Information
Summary) consent had been recorded where appropriate.
Findings
Conclusions
To improve our care for dementia patients and their carers, coding of carers for dementia
patients in the practice needs to be more consistent. Similarly for patients who act as carers
for dementia patients. Coding in both cases should be Priority 1, so it can be seen in the
patient’s summary.
Documentation of carer details should be recorded consistently in the correct place so that
information is easily accessible / notes are linked for use during day-to-day general practice,
and so that carer information is readily accessible where KIS consent has been given for
Out-of-Hours services.
For patients with ACPs or other ECS relevant information, KIS consent must be organised so
that relevant information is accessible to Out-of-Hours services.
A total of 113 patients were coded as having a diagnosis of dementia.
64 of these patients live at home, for whom the findings were as follows:Carers
Applications to practice
42 patients had carers, only 23 were coded as priority 1 (55%), 16 coded as priority 3 or 7
(35.5%) 4 were not coded at all (9.5%).
30 patients were carers, only 10 were coded as priority 1 (33%), 4 coded as priority 3 or 7
(14%), 16 were not coded at all (53%).
Guidance has been given to practice staff regarding the documentation and coding of carers,
in particular for dementia reviews as many dementia patients had carers added to the notes
at this point, usually as a priority 3, but rarely adding the carer as such in their notes.
Similarly, regarding the area for documentation of carer’s details – administration staff will
also be involve in this to ensure this is correctly recorded.
Carer coded as
Priority 1
A reminder has been given regarding the importance of KIS consent for relevant patients.
Information will be cascaded to staff regarding the significance of the carer role and ways in
which we can help support both patient and carer, for example contact with Alzheimer's
Scotland.
Carer coded as
Priority 3 or 7
Personal Learning from Dementia Scholarship
25
23
20
16
15
15
10
10
Carer not
coded
5
4
4
0
Dementia patients with carers
(N=42)
The scholarship has covered a great breadth of information about dementia and allowed me
to gain a significantly greater understanding of diagnosis, medications, management of
behaviour that challenges, the role of scanning, and the legal aspects around dementia. By
having the opportunity to job shadow colleagues in Old Age Psychiatry and Radiology I have
gained a very useful insight in the assessment and longer term management of this important
condition in the community.
Patients who are dementia
carers (N=30)
References
1. Common core principles for supporting people with dementia: a guide to training the social care and
health workforce. Policy – Treating patients and service users with respect, dignity and compassion.
Department of Health 9.6.2011. www.gov.uk/government/publications