JANUARY 14, 2016

CIRAC PROJECT-WHAT IT IS CIRAC=COGNITIVE IMPAIRMENT RECOGNITION IN ACUTE CARE A CHH PARTNERSHIP WITH THE ALZHEIMER’S ASSOCIATION A WAY TO RECOGNIZE UNUSUAL BEHAVIORS AS AN INDICATOR OF POSSIBLE COGNITIVE IMPAIRMENT “SEE SOMETHING, SAY SOMETHING”

CIRAC PROJECT-WHY IS IT IMPORTANT FAILURE TO RECOGNIZE COGNITIVE IMPAIRMENT IN HOSPITALIZED PATIENTS LEADS TO POOR OUTCOMES MANY SIGNS OF COGNITIVE CHANGES ARE SUBTLE AND MAY BE IGNORED OR NOT RECOGNIZED UP TO 45% OF HOSPITALIZED ELDERS MAY HAVE COGNITIVE IMPAIRMENT LEADS TO POOR TRANSITIONS OF CARE AND DISCHARGE PLANNING

CIRAC PROJECT-GOALS IDENTIFY COGNITIVE IMPAIRMENT EARLY, BY WAY OF “UNIVERSAL OBSERVATIONS”, AND ENSURE THE DOCTOR KNOW ABOUT THE FINDINGS INCREASE SAFETY AND SATISFACTION DECREASE LENGTH OF STAY DECREASE READMISSIONS IMPROVE TRANSITIONS OF CARE IMPROVE FOLLOW UP AND CONTINUITY

CIRAC “Light is good from whatever lamp it shines.” ~Author Unknown Therefore , first cornerstone principle for CIRAC is “Universal Observations”

CIRAC-UNIVERSAL OBSERVATIONS Universal Observations is an approach to recognition of cognitive impairment. According to the concept of Universal Observations, all patients should be looked upon, by all staff, as being at risk for, and possibly having, cognitive impairment.

CIRAC-UNIVERSAL PRECAUTIONS ALL Hospital/Acute Care staff members observe patients. Registration, nursing, laboratory and radiology, housekeeping, security, volunteers, dietary… Behaviors and appearances possibly indicative of Cognitive Impairment are reported to clinical staff who can follow up. If you See Something, Say Something.

RED FLAGS-BEHAVIORS What should trigger a report to a clinical staff member? Some abnormal behaviors are fairly obvious: Patient has fallen Pt. is screaming or crying Pt. throws something at a staff member Pt. cannot be awakened Pt. acts paranoid, is having hallucinations, talks “out of their head” **If unsafe-call for help

RED FLAGS-BEHAVIORS Some behaviors are equally important but not as obvious: Pt. described as “Poor Historian” Pt. is given food tray but makes no attempt to eat, especially if more than one meal Repeatedly fails to follow instructions or answer questions Appears “bewildered” Unexpectedly wets or soils bed Becomes extremely agitated over a small matter Others

SEE SOMETHING/SAY SOMETHING See something/Say something means: You (whomever you are) see something (a red flag behavior), and you say something (verbal or written) to a clinical person who knows the patient (a nurse, midlevel provider, doctor) No one has to do a screening test No one has to make a diagnosis except the doctor

SEE SOMETHING/SAY SOMETHING See something / say something does NOT: Label the patient Cause a diagnosis to be entered in the chart But it should: Lead to further inquiry And if pt. confirmed as cognitively impaired, can allow them to be identified. Identification leads to allowing pt’s status to be known to others and evaluation as needed Primary goal: Recognition

SEE SOMETHING/SAY SOMETHING Reporting to nursing staff Verbal is acceptable, especially nurse-to-nurse Other staff to nurse – written observation Purple Notebooks provided

PROCESS-ANY STAFF Staff recognizes indicator of cognitive impairment/Unusual behaviors or “red flags” ***Staff reports/documents behavior in purple binder log at nurse’s station. ***If the Patient is wearing an ORANGE Armband, then you will not need to log the behavior in the purple binder.

PROCESS-NURSING Charge nurse reviews entries on the log in the purple binder Charge nurse determines behavior may be due to unrecognized cognitive impairment. Charge nurse reports to admitting Provider

SEE SOMETHING/SAY SOMETHING Communication of patient’s Cognitive Impairment to others in the Acute Care setting: -Confirm it: See something/say something leads to clinician recognition of Cognitive Impairment -Chart it: Nurse/clinical provider documents Cognitive Impairment and/or a diagnosis in patient’s chart -Convey the information: Identify patient to others in the Acute Care setting

Patient identifier implemented PROCESS FOR KNOWN COGNITIVE IMPAIRMENT Patient or family member discloses presence of cognitive impairment, Alzheimer’s or another dementia to staff member Staff documents in Admission History and Reviews Physician H&P for confirmation of diagnosis Patient identifier implemented ORANGE ARMBAND

SUMMARY Notification of house wide implementation date. ***Will notify everyone of GO-LIVE date CIRAC Project Empowers all Hospital staff/volunteers who come in contact with patients to report unusual behaviors. Standardized process (documentation in purple binders) to improve recognition, awareness, safety, and reporting. Improves patient care, continuity, follow up and transitions.

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