A better way to care for patients with cognitive impairment

By ahhb
Wednesday, 22 April, 2015

The Australian Commission on Safety and Quality in Health Care (the Commission) has released new resources for health professionals and consumers to improve the identification of and response to cognitive impairment in hospitals both system-wide and clinically.

Cognitive impairment (dementia and delirium) is common among older people admitted to hospital. Around 30 per cent of patients in Australian hospitals who are aged over 70 have some form of cognitive impairment. As our population ages the number of people with cognitive impairment in hospital will increase.
Patients with cognitive impairment are at greater risk of adverse outcomes and preventable complications such as falls, pressure injuries and functional decline. These patients are also likely to stay in hospital longer and are more likely to be readmitted.
The Australian Commission on Safety and Quality in Health Care (the Commission) has released A better way to care: Safety and quality for patients with cognitive impairment (dementia and delirium) in hospital. The resources use evidence-based best practice to guide health services in making improvements. They guide clinicians through a safety and quality pathway for patients with cognitive impairment in hospital. The pathway has three steps:
1. being alert to delirium and the risk of harm for patients with cognitive impairment
2. recognising and responding to patients with cognitive impairment
3. providing safe and high-quality care tailored to the patient’s needs, in partnership with patients, carers and families.
The key mechanisms to implement the pathways are:
1. develop responsive systems in hospital
2. ensure a skilled and informed workforce
3. partner with patients, carers and families.
The key strategies in the resources have been linked to the existing National Safety and Quality Health Service (NSQHS) Standards so that, during accreditation, organisations can use the examples of cognitive impairment to demonstrate what they have in place for high risk groups.
For many organisations, the resources will reinforce the importance of what they are already doing in recognising cognitive impairment as a quality and safety issue. For those that identify that improvements are necessary, the A better way to care resources can guide quality improvement.
In addition to the release of A better way to care, the Commission will include key strategies in recommendations for strengthening the NSQHS Standards as they are reviewed over the next two years.

The Commission is also developing a clinical care standard for delirium in 2015. The NSQHS Standards focus on system level change, structures and processes. As an important parallel process, and linked to the NSQHS Standards, Clinical Care Standards focus on appropriate clinical care for a specific condition where there is a gap between evidence and practice.
The Delirium Clinical Care Standard will outline the key components of clinical care with accompanying indicators. It will guide clinical practice and facilitate the provision of appropriate clinical care for patients with cognitive impairment.
The Department of Social Services provided funding to the Commission for this project as part of changes in aged care and, specifically, through funding targeted to improve the care of people with dementia in acute care.

“For many organisations, the resources will reinforce the importance of what they are already doing in recognising cognitive impairment as a quality and safety issue. For those that identify that improvements are necessary, the A better way to care resources can guide quality improvement.”

For more information, and to download A better way to care: Safety and quality for patients with cognitive impairment (dementia and delirium) in hospital resources, visit www.safetyandquality.gov.au/ourwork/ cognitive-impairment/betterway- to-care/.
The clinician version of A better way to care will also be available as an app from the Google Play Store or via the iTunes App Store later in 2015.
The Australian Commission on Safety and Quality in Health Care has released new resources for health service managers, clinicians and consumers to improve the identification of, and response to, cognitive impairment in hospitals, both system-wide and clinically.