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VISITING a colleague recently, I was pleased to see a dog-eared and coffee-stained copy of A better way to care: safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital on the table in his office.
This resource, developed by the Australian Commission on Safety and Quality in Health Care and published last year, encourages clinicians to watch out for signs of cognitive impairment in their patients, to recognise the safety risks and respond by providing high-quality care tailored to the patient’s individual needs.
This is not something we always do well in acute hospitals, but timely and appropriate care does make a huge difference to outcomes for these patients.
My colleague had been working on a clinical redesign program looking at better care for older people who require acute hospital admission. He quickly realised that one thing the hospital really needed to improve was their management of dementia and delirium.
Enter A better way to care. This resource for clinicians on recognising and managing cognitive impairment provided the basis for him and his colleagues to drive change in his hospital. There are also resources for health service managers and consumers.
We know we have an ageing population. The recent Intergenerational Report is one of a long line of reports that highlight this issue.
As our population ages, we’ll see more patients presenting to hospital with cognitive impairment. Delirium is a common presenting symptom to emergency departments, and a frequent accompaniment with other admissions.
In hospital, patients with dementia are twice as likely to experience falls, pressure injuries and develop hospital-acquired infections. They are also six times more likely to develop delirium.
A better way to care tells us that we must not dismiss these patients as just old, not coping, or “pleasantly confused”, a description that has been used in hospital notes.
If a patient has existing dementia, we can put strategies in place to prevent complications and make their stay safer. If a patient has delirium, then it must be treated as a medical emergency.
Backed by a strong evidence base, the resources present a pathway for providing safe and high-quality care to patients with cognitive impairment, and offer three real-life patient case studies to illustrate how the pathway works in practice.
To give clinicians quick access to the resource, an app for mobile devices has just been released (search for “A better way to care” in your app store). Access to the full suite of resources and more information about the Australian Commission on Safety and Quality in Health Care’s work is available at www.safetyandquality.gov.au/betterwaytocare
As more health care professionals implement the strategies outlined in these resources, I look forward to seeing cognitive impairment, particularly delirium, better identified and managed in acute care.
And I look forward to no longer seeing the phrase “pleasantly confused” in clinical records.
Professor Susan Kurrle is a geriatrician at Hornsby Ku-ring-gai Hospital in northern Sydney and at Batemans Bay Hospital in southern NSW. She also holds the Curran Chair in Health Care of Older People in the Faculty of Medicine at the University of Sydney. She has had a long interest in the diagnosis and management of people with dementia, and leads the NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People. Professor Kurrle was the Australian Commission on Safety and Quality in Health Care medical consultant in the development of “A better way to care”.
Very interesting article. However, having had extensive experience myself with dementia patients in hospital settings and nursing home settings. I continually come across the same repetitive things from AINs (assistance in nursing) and other trained proffessionals. I like to call it information overload. I have observed over many many years that if an AIN in a hospital setting has been assigned the job of ‘special’, that is to watch over a pt due to impulsive behaviors so the pt remains safe until reviewed. Definitely no discrimination intended but with so many major language barriers either from the pt or the staff, more often the staff person is unable to speak clearly enough to be understood to a person who has congnitive decline or delerium. Too much information is given to the pt to get them to follow basic instructions. No training offered in hospitals or nursing homes to be able to manage dementia clients. Not enough staffing to better cope with the needs of high needs pt. People that design placement facilities for clients with dementia need to look very carefully at design layouts of rooms, bathrooms, dining room set ups and special facilities for people with remaining motor skills to have access to activities within a safe environment and properly trained and dedicated staff.