1. 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

2. Assuring Delirium Care

3. 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

4. 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.

5. 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.

7. Listen to experience

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

10. 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; )

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

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

13. Education
Triggers
Systematic approach to process
Risk reduction
Stress and Distress

14. ALERTNESS
AMT 4
ATTENTION
ACUTE CHANGE

15. TIME Bundle

18. Speak to families and carers

19. 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:
deLangeE, et al. Int. Jrnl. Geri. Psychiatry 2013; 28;
Fick D. J HospMed Sep;8(9):500-5.)

20. 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?

21. Think about vulnerability

22. 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

23. 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

24. Framework for planned Improvement
Measure Evaluate Improve- create concensus

26. Thank you