A better way to care Safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital Presented by: Mark Howland CNC Dementia (Community) Tablelands and Mehi Clusters AUSTRALIAN COMMISSION on SAFETY and QUALITY in HEALTH CARE

Overview of presentation The future; our aging population Dementia and Delirium in that population A better way to care –NSQHS link – 3 specific resources – Folders Buy in and rollout

Dementia rates worldwide are increasing and Australia is no exception. It is thought that the number of people with dementia in NSW will increase fourfold from 84,000 in 2009 to 341,000 in (Source: Access Economics – Dementia Framework.) This makes it one of the fastest growing sources of major disease burden. It is now the third leading cause of death after heart disease and stroke. Dementia in our Aging our Aging Population

Dementia Prevalence by age Groups 2010 and 2030 (Predicted)

The impact of dementia & delirium on LHDs People with dementia have unacceptably worse clinical outcomes with longer LOS (8.6, 19.6 & 30.1), higher mortality as well as a higher likelihood for readmission compared to people without dementia. High falls risk Bed days are being used up inappropriately Costs I am sure you have heard more bad stories!

This is what we are aiming for!

Cognitive Impairment and the NSQHS Standards Cognitive impairment is recognised as a quality and safety issue that needs to addressed in the new Standards Standards 1, 2, 4, 6, 9 and 10 are particularly important for cognitive impairment Pathway and issues raised by cognitive impairment are also applicable to others Organisations are grappling with how to integrate multiple risk factors A new stand alone standard for cognitive impairment would not address the issue of integrated care.

A better way to care - Resources Collation of evidence and best practice into 3 resources for –health service managers, –clinicians and –consumers, A better way to careA better way to care Dementia and Delirium PostersDementiaDelirium Dementia and Delirium InfograficsInfografics

Purpose This resource describes a pathway to improve the early recognition of, and response to, patients with cognitive impairment to reduce harm and ensure they receive safe and high-quality care in hospital. The steps in the pathway are consistent with the intent of the NSQHS Standards.

Hospitals should aim to: Make sure that everyone working in the hospital is aware of dementia and delirium, the possible harm that can occur if the right care is not provided, and how they can help to prevent delirium Recognise when a patient has cognitive impairment and find out what is causing it Work with patients, carers and families to provide safe and high-quality care for people with cognitive impairment Australian Commission on Safety and Quality in Health Care. A better way to care: Safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital – Actions for consumers. Sydney; ACSQHC, 2014.

Pathway for patients with cognitive impairment Pathway How do we develop a pathway and then being able to prove to others that we do?

The three steps

What is Dementia and Delirium? Face to face education On line resources External education opportunities Site Champions

Mechanism 1: Establish responsive systems Mechanism 2: Ensure a skilled and informed workforce Mechanism 3: Enable partnerships between clinicians, patients, carers and families

What can managers do to make improvement happen? Implementing systems Monitoring and Supporting System Improvements

Implementing Systems Implementing systems –Establish mechanisms for alerting the workforce to patients at risk of harm due to cognitive impairment. –Establish systems to document informed consent and substitute decision-maker. Satisfies criteria for: Establish and implement systems to enable the workforce to be alert to the risk of delirium and harm NSQHS Standards action: 1.8.1

Evidence …Policies, procedures and protocols available to guide the workforce in being alert to patients at increased risk of harm and delirium ……Risk register that includes actions to address identified risks ……Relevant documentation from committees and meetings that details data analysis, improvement and actions taken ……Analysis of patient experience surveys and identification of organisational responses to issues

What next? Executive buy in – systems and champions Education that encompasses the cognitive impairment pathway as an integral part of patient care A folder in each inpatient unit that supports staff to follow the pathway, physical resources and links to online resources Your comments?

References Dementia Care in the Acute Hospital Setting: Issues and Strategies A REPORT FOR ALZHEIMER'S AUSTRALIA PAPER 40 June 2014 Australian Commission on Safety and Quality in Health Care. A better way to care: Safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital – Actions for clinicians. Sydney; ACSQHC, Australian Commission on Safety and Quality in Health Care. A better way to care: Safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital – Actions for consumers. Sydney; ACSQHC, Australian Commission on Safety and Quality in Health Care. A better way to care: Safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital – Actions for Health Service Managers. Sydney; ACSQHC, People with dementia in hospitals in New South Wales 2006–07 Bulletin 110 NOVEMBER 2012 Care of Confused Hospitalised Older Persons, Agency for Clinical Innovation 2015 Web pages