Karen Goudie National Clinical Lead Think Delirium In a nutshell: It is understood that patients with dementia and/or delirium are exposed to more patient safety risks than the general population; with increasing numbers of people living with these conditions it is more important than ever to equip staff with the right tools to deliver safe person-centred care. The improvement Academy is working with experts in caring for people with dementia and delirium, learning what works in practice and how to make sustainable improvements.  Karen Goudie National Clinical Lead

Assuring Delirium Care

Policy and Standards Appropriateness Availability Continuity Respect and Caring Efficacy H&SC Delivery Plan to set out the framework and actions needed to ensure that our health and social care services are fit to meet the challenges of our changing society. The 2020 Vision provides the strategic narrative and context for taking forward the implementation of the Quality Strategy, and the required actions to improve efficiency and achieve financial sustainability. The Scottish Government's 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting and, that we will have a healthcare system where: Quality strategy refined for H&SC -- Six should be Eleven for H&SC Efficacy, Appropriateness, Availability , Continuity, Respect and Caring

Standard 8 Webex 24th September The new standards build on the previous standards from 2002, with a greater focus on initial assessment on admission and more complex aspects of care.

Think delirium Our Challenge.. helping staff understand and see the process of gold standard Delirium care. Testing innovative approach to delirium care throughout Scottish Acute Hospitals Health outcomes associated with delirium = process. Our challenge helping staff see the process. Delirium is associated with poor outcomes for older people with 1 in % people dead within 1 mth after development. Delirium can be considered HARM in acute care to those patients with a diagnosis of dementia.

Listen to experience

OPAH Inspection Proportionate Multidisciplinary Driven by data Report reflects overall reliability Support time for QI Appreciation of data over time

Risk Factors for Delirium Multi-factorial Advanced Age Dementia/Frailty Illness Multiple Medications Functional deficits Dehydration Pain and Depression Immobility Sensory Impairment (deLange E, et al. Int. Jrnl. Geri. Psychiatry 2013; 28; 127-134)

Around a third of delirium is Preventable Care planning can have significant impact CGA Fundamentals of Care

Vulnerability Use process to find Delirium Seek carer, family Early recognition Risk to those with Hypoactive delirium Think about Hospital acquired delirium

Education Triggers Systematic approach to process Risk reduction Stress and Distress

ALERTNESS AMT 4 ATTENTION ACUTE CHANGE

TIME Bundle

Speak to families and carers

What Next for Think Delirium ? Up to 70% in patients admitted to Long Term Care. 34% Hypoactive 24% Hyperactive 42% Mixed type Substantially worsens outcomes in a population who are already burdened by functional decline Delirium in older adults is poorly recognized and poorly noted on discharge Over 80% were on central nervous system active drugs Length of stay was significantly higher in patients with delirium (Inouye SK. Delirium in older persons. N EnglJ Med 2006; 354:1157-1165. deLangeE, et al. Int. Jrnl. Geri. Psychiatry 2013; 28; 127-134 Fick D. J HospMed. 2013 Sep;8(9):500-5.)

Do we routinely assess risk of delirium when we admit residents to our care home? Do staff involved in admitting residents know the risk factors for delirium? Where do we record in resident’s notes that we have assessed their risk of developing delirium? For those people at risk of delirium, do care staff know that they should monitor them for recent changes in behaviour , including cognition, perception, physical function and social behaviour? If there are concerns that a resident has developed delirium, do care staff know how to request a clinical assessment?

Think about vulnerability

Reducing risk of falling Falls are the most common adverse incident in hospitals and care homes, nearly always affecting frail elderly people, many of whom have dementia or delirium Risk management must be balanced against the need to promote functional independence and to respect autonomy

Assurances Process Improvement Activity External Assurance Walk rounds Data Review #7 Stories Peer Review Standards Improvement Activity ihub Scottish Government External Assurance OPAH QOCR HAI HEI HSE Patient reported Outcomes GAP ANALYSIS Quality Planning/Self Assessment Improvement Control Local and external Assurance, SAER Learning Celebrating Excellence developing Improvers Sharing Practice, Evidence and innovation Design and solution development CAIR Intelligence Intelligence to ACTION Policy direction and planning from robust data Data to action – combined indicators/ drill down into system to investigate a potential area of concern, standardisation of care QOCR Workforce data /Educational attainment Evidence based data - nursing indicators – data validation – testing Research opportunities Staff reported Outcomes REDUCE VARIATION

Framework for planned Improvement Measure Evaluate Improve- create concensus

Thank you