Cognitive impairment, such as dementia and delirium, impedes communication, attention, memory, thinking and problem solving and can cause great distress for patients in hospital, as well as their loved ones and carers – making it an important safety and quality issue for all Australian hospitals.
To help improve outcomes for people with cognitive impairment, the Australian Commission on Safety and Quality in Health Care (ACSQHC) has developed a new campaign targeting hospital-based health professionals and carers.
Chair of the ACSQHC Board, Professor Villis Marshall AC has provided the following information about the aims and content of this campaign.
Professor Villis writes:
Nationally, 20% of hospital patients aged over 70 have dementia and 10% of patients in this age group have delirium on admission to hospital, and patients with dementia are two times more likely to experience falls, pressure injuries or infections in hospital.
Patients with cognitive impairment have poorer outcomes, including increased mortality, more adverse events such as falls, infections and pressure injuries, an accelerated rate of cognitive and functional decline, longer hospital stays, more unplanned re-admissions and increased entry to residential care.
Any form of cognitive impairment, including intellectual disability or brain injury, has risks associated with being in an unfamiliar environment surrounded by unfamiliar, busy people who don’t know their particular needs. There can be difficulties with communication and following instructions. A person may become agitated trying to express something such as pain but there is a tendency to blame any behavioural changes on the person’s disability rather than looking for possible underlying physical causes.
The need for careful diagnosis
Similarly, symptoms of delirium can be passed over with an attitude such as “patients from nursing homes are often confused” rather than recognising the need to investigate. Cognitive impairment is often not detected, or is dismissed or misdiagnosed, but it is crucial to distinguish delirium from dementia and to investigate it properly, as it may be the only sign of an acute, underlying, serious illness.
The Australian Commission on Safety and Quality in Health Care has embarked on a campaign to address these issues. The Caring for Cognitive Impairment campaign will improve knowledge and care practises to provide better outcomes and reduce the risk of harm to people with cognitive impairment in hospital. Many of the national leaders in this field are providing advice, guidance and leadership to the campaign through the Commission’s Cognitive Impairment Advisory Group.
Collaboration and early identification
The campaign highlights the fact that harm can be minimised if cognitive impairment is identified early and steps are taken to reduce the associated risks. It encourages everyone working in hospitals, people in the community and consumers to get involved and make a difference.
In an effort to harness and share the good work and practise found in hospitals across the country, the campaign creates opportunities to learn from others. Many hospitals and organisations are already making improvements – screening for cognitive impairment, identifying delirium risk, assessing for delirium, improving communication and caring for people with cognitive impairment with dignity, respect and compassion, educating staff about ways to reduce distress, improving the environment and putting practical strategies in place to work in partnership with consumers. These initiatives are critical components to provide high quality care for people with cognitive impairment.
The role of carers and families
The campaign places equal emphasis on the role of carers and loved ones, whose involvement is crucial in high quality care for people with cognitive impairment. They can help communicate a person’s history, provide informed consent if they are the person responsible, provide a reassuring, familiar presence and help prevent delirium, and alert staff to ways to reduce the person’s distress. They are often experts and need to be listened to and respected.
The campaign will open up opportunities to share stories and helpful tips to address the challenges faced in implementing change. Everyone involved with the campaign will have access to resources, webinars and regular newsletters.
The campaign follows on from the Commission’s resource, A Better Way to Care, which collated current evidence and best practise for delirium and dementia recognition and care.
A clinical care standard
The Commission is also developing a Clinical Care Standard that outlines the key components of clinical care for patients with suspected delirium and patients at risk of developing delirium in hospital. It is intended to guide clinical practice and facilitate the provision of appropriate clinical care. It is anticipated the Clinical Care Standard will be released later this year, following approval, and will be accompanied by a set of indicators to support clinical teams and health services to identify and address areas that require improvement at a local level.
In addition, the current National Safety and Quality Health Service (NSQHS) Standards have been reviewed and cognitive impairment has been incorporated into the draft consultation version 2 of the NSQHS Standards. As it is with the Caring for Cognitive Impairment campaign, the emphasis of communicating with and involving consumers in their own care is an important aspect of the draft version 2 of the NSQHS Standards, which will enable inclusion of a person’s preferences and personal circumstances into the decision making process.
The NSQHS Standards
Once the draft consultation version 2 of the NSQHS Standards are finalised and approved by the health ministers, all hospitals and day procedure services (and the majority of public dental services) across Australia will need to demonstrate implementation of these new cognitive impairment items through accreditation processes. The draft version 2 of NSQHS Standards have been the subject to extensive consultation and the inclusion of items to address cognitive impairment have been welcomed, but at the same time there is recognition that health services will benefit from knowledge, support, resources and the lessons learnt from others who have already implemented initiatives. This is where the Caring for Cognitive Impairment Campaign will help.
The campaign is a call for action to unite everyone who cares for people with cognitive impairment, the campaign website also enables individuals to commit to the campaign. Doctors, nurses, allied health professionals, health service managers, hospital care and support staff, workers in primary health or community care, patients and families can all make a difference. Key organisations, including Alzheimer’s Australia, have joined the campaign as supporters and will be promoting the importance of the campaign and influencing their members to take up the commitment. Visit: http://cognitivecare.gov.au/
Professor Villis Marshall AC is the Board Chair of the Australian Commission on Safety and Quality in Health Care