1. Re-auditing compliance with NICE guidance on completion of a basic dementia screen prior to treatment
David M Williams, Rose Anderson, Joel D Handley, Selwyn Albuquerque
Cefn Coed Hospital, Waunarlwydd Road, Cockett, Swansea, SA2 0GH
Background
Physical assessment to exclude other causes of memory loss is essential in patients referred for Dementia. Treatment of physical causes of memory impairment can completely reverse such problems. The assessment is reflected in NICE guidelines1 for Dementia. This should include a physical examination, a series of blood tests, urinalysis and neuroimaging. Blood tests should at least include1:
Full Blood Count (FBC),
Urea & Electrolytes (U&Es),
C-Reactive Protein/Erythrocyte Sedimentation Rate (CRP/ESR)
Liver Function Tests (LFTs),
Thyroid Function Tests (TFTs),
Calcium,
Glucose,
Vitamin B12/Folate levels
We recently audited our own compliance with this guideline. We found that less than half of our patients had documented CRP/ESR and MSU. Following a six month period, we will re- audit to determine any changes in our practice.
Methods
Retrospective analysis of all patients commenced on medication for memory loss over the previous 6 months was performed using online hospital systems and patient notes. We determined whether patients had each of the blood tests listed above, as well as urinalysis and neuroimaging as recommended. We expect that all patients commenced on pharmacological intervention for Dementia will have a fully documented confusion screen.
Results
We identified 18 new patient referrals to the memory clinic over the previous six months who had been initiated on pharmacotherapy for dementia. They were 61% female, and their dementia diagnoses are summarised and compared to the previous audit in Figure 1.
All patients had a documented initial cognitive assessment. Figure 2 demonstrates FBC and U+Es were documented in 100% of cases. However, CRP/ESR (56%), LFTs (89%), TFTs (89%), calcium (72%), glucose (89%), B12/folate (72%), and MSU (50%) were not documented in all patients. Neuroimaging was again performed in all cases.
Discussion
These data demonstrate that whilst generally compliant with guidelines on the physical assessment of suspected dementia patients, there is further room for improvement.
This audit shows generally some improvements in our documentation of the recommended blood tests in current NICE guidelines. However, there continues to be a significant proportion of patients without documented urinanalysis and inflammatory markers. This highlights the need for further ongoing work to continue to improve our practice.
Further Work
Data will be presented locally to memory clinic staff and re- audited in 6 months.
References
1. NICE. (2006). “Dementia: Supporting People with Dementia and their Carers in Health and Social Care”. Clinical guideline 42. Available at
March September
Figure 1 compares the proportion of diagnoses made of patients initiated on drug therapy for memory loss in each audit.
Figure 2 compares the proportion of patients (%) with documented blood and urine tests performed prior to pharmacological intervention in each audit performed.