Fourth round of audit

Data collection for round 4 is now closed and the report will be published in Summer 2019.

NAD Round 4 (2018-2019)


Round 4 will mostly be a repeat of Round 3, with some additions and changes based on feedback from participants, Service User Review Panels and the Steering Group.

View the Round 4 standards (pdf) that will be audited during this round of the National Audit of Dementia.

Outlier policy

Identifying outliers and informing Trusts (docx)

Data collection tools

Guidance for data collection tools

Scoring guidance

Scoring was used in Round 3 of the audit. This will be repeated in Round 4 for easy comparison between hospitals on the different themes of the audit. The Round 4 National Report will compare results and scores for each hospital with the results from Round 3. See the guidance for the scoring system (pdf).



Average hospital scores across England and Wales (NAD Round 3)

Round 4 includes a spotlight audit on the 'Prescription of Psychotropic Medication', this module will form part of the Quality Account in 2019. Data collection for the spotlight audit will take place between June and July 2019.


Please register for the spotlight audit via the following link:

Due to the sampling methodology, unfortunately this spotlight audit will only be available to hospitals who have implemented electronic prescribing systems:

  • If you do not have e-prescribing in your hospital: Please indicate this on the registration form to confirm that your hospital is ineligible.
  • If you are eligible but are not taking part in the spotlight audit: Please confirm this via email (including the reason why you are not taking part) to cc'ing your medical director.


NICE guideline CG42, section People with dementia who develop non-cognitive symptoms or behaviour that challenges should be offered a pharmacological intervention in the first instance only if they are severely distressed or there is an immediate risk of harm to the person or others.

This module was developed based on the advice contained in NICE guideline CG42 (now updated) and aims to explore prescriptions of any psychotropic medication to people with dementia in hospital, ascertaining:

  • The number of people with dementia taking already prescribed medication
  • The number of people with dementia whose prescription originated in hospital
  • The number of people with dementia who were discharged with a prescription in place
  • The dosage, dosage route and target symptoms recorded for each medication prescribed
  • The number of prescriptions that were reviewed on discharge
  • For prescription of antipsychotic medications, whether there is any record that a non-pharmacological intervention was attempted prior to prescription

Reporting will examine variance in prescribing practice and to look at whether the decrease nationally in prescription of antipsychotic medications has led to an increase in prescription of other medications for behavioural and psychological symptoms of dementia.

Our online privacy notice gives you detailed information on when and why we collect personal information and how we use it.

Carer and staff surveys are anonymous and case note audit submissions are pseudonymised (we do not ask for any identifying information such as name or NHS number, and allocate a number just for the purposes of audit, for further details please refer to our data flow chart (xls). We have completed a Data Protection Impact Assessment (DPIA) to review our management of these data.

Data collection is via an online audit tool using Formic’s Fusion Survey software. Formic abide by the stringent security requirements of the NHS for its systems and processes. Please see the following data security statement on the Formic data collection software.

The optional casenote audit allows hospitals who wish to participate to build a year on year record of performance to submit further cases. The questions in the optional casenote are identical to the Round 4 casenote audit tool.

Data collection for the optional casenote audit is open until 20th September 2019 and data can be submitted online at You will need your Round 4 login details and hospital code to begin. Please contact the NAD Team if you need your login details.

If you would like to participate but have not yet registered, you still have time to fill in your details.



Sampling guidance (doc)

Question guidance (doc)

Throughout September and October 2019, we will be facilitating quality improvement workshops around England and Wales. The aim of these workshops is to develop practical applications to address hospital-specific shortfalls identified following the National Audit of Dementia Round 4 report. These workshops are open to audit leads, clinicians, QI and governance personnel and any other interested staff.  Further details will be provided in due course.

Workshop dates:

  • Tuesday 3rd September 2019 - London (Hallam Conference Centre)
  • Monday 9th September 2019 - York (Park Inn by Radison)
  • Thursday 12th September 2019 - Cardiff (All Nations Centre)
  • Monday 16th September 2019 - Birmingham (The Priory Rooms)
  • Friday 27th September 2019 - Manchester (The Manchester Meeting Place)
  • Tuesday 8th October 2019 - Bristol (Engine Shed)
  • Monday 14th October 2019 - London (Hallam Conference Centre)

How to register

You will be able to register for up to 2 places per hospital but if places become available there will be a reserves list should you wish to add more attendees. If so, please email the NAD team with hospital name, additional attendee name, email and selected workshop.

Opportunities to present:

We are inviting any participants who have implemented Quality Improvement projects following our last workshops to share with the group what they have implement through short presentations of 5-10 minutes (presentation templates will be provided). If you are interested please contact the NAD team and we will forward you the relevant resources.

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