This action states

Clinicians providing care to patients who have cognitive impairment or are at risk of developing delirium use the system for caring for patients with cognitive impairment to:

  1. Recognise, prevent, treat and manage cognitive impairment
  2. Collaborate with patients, carers and families to understand the patient and implement individualised strategies that minimise any anxiety or distress while they are receiving care

Intent

Risks are minimised by undertaking strategies to recognise, prevent, treat and manage cognitive impairment. Clinicians, patients, carers and families work together to minimise anxiety or distress experienced by the person with cognitive impairment.

Reflective questions

How is the workforce supported to recognise, prevent, treat and manage cognitive impairment?

How is feedback from patients with cognitive impairment, and their carers and families collected and used to inform improvement strategies?

Key tasks

  • Review and, if necessary, revise the organisation’s education and training program to support implementation.

  • Provide access to education and training about the system that supports caring for patients with cognitive impairment, and agreed tools and responsibilities.

  • Work with clinicians and consumers to design and implement systems for working together and for implementing strategies to minimise anxiety and distress experienced by a person with cognitive impairment.

  • Use regular feedback from patients, carers and families to improve collaboration.

Strategies for improvement

Hospitals

The whole workforce has a role in providing care and creating a person-centred culture. This means that all levels of the workforce need access to continual, targeted education, information and training.

Provide orientation, education and training for the workforce to understand their individual roles, responsibilities and accountabilities in working with patients, carers and families to prevent and reduce the risk of harm for people with cognitive impairment or at risk of developing delirium.

Include information about forms of cognitive impairment other than dementia and delirium, because people with other forms of cognitive impairment also have poor experiences.1

Ensure that training and education programs cover the elements of the system for caring for cognitive impairment described in Action 5.29.

Multifaceted education programs that include enabling and reinforcing techniques can result in positive outcomes for patients.2

Consider liaising with Dementia Training AustraliaDementia Support Australia and Dementia Australia.

Consider developing initiatives such as recruiting cognitive champions who can reinforce education, offer peer support to help clinicians improve their skills and confidence, and organise relevant resources for their wards.3

Consider implementing evidence-based programs, such as TOP 5, that assist clinicians and carers to work together to reduce a person’s distress. Well-structured and well-supported volunteer programs and modification of the environment (see Action 1.29) can also help to reduce a person’s distress.

Day Procedure Services

Pre-admission screening should identify patients with cognitive impairment or at risk of delirium, to trigger strategies to keep the patient safe and to minimise potential distress.

If the day procedure service admits patients who have cognitive impairment or are identified as being at risk of developing delirium, the service should have processes to ensure that clinicians are aware of the systems outlined in Action 5.29.

Refer to the hospitals tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

The whole workforce has a role in providing care and creating a person-centred culture. This means that all levels of the workforce need access to continual, targeted education, information and training.

Provide orientation, education and training for the workforce to understand their individual roles, responsibilities and accountabilities in working with patients, carers and families to prevent and reduce the risk of harm for people with cognitive impairment or at risk of developing delirium.

Include information about forms of cognitive impairment other than dementia and delirium, because people with other forms of cognitive impairment also have poor experiences.1

Consider liaising with Dementia Training AustraliaDementia Support Australia and Dementia Australia.

Consider developing initiatives such as recruiting cognitive champions who can reinforce education, offer peer support to help clinicians improve their skills and confidence, and organise relevant resources for their wards.3

Consider implementing evidence-based programs, such as TOP 5, that assist clinicians and carers to work together to reduce a person’s distress. Well-structured and well-supported volunteer programs and modification of the environment (see Action 1.29) can also help to reduce a person’s distress.

Hospitals

The whole workforce has a role in providing care and creating a person-centred culture. This means that all levels of the workforce need access to continual, targeted education, information and training.

Provide orientation, education and training for the workforce to understand their individual roles, responsibilities and accountabilities in working with patients, carers and families to prevent and reduce the risk of harm for people with cognitive impairment or at risk of developing delirium.

Include information about forms of cognitive impairment other than dementia and delirium, because people with other forms of cognitive impairment also have poor experiences.1

Ensure that training and education programs cover the elements of the system for caring for cognitive impairment described in Action 5.29.

Multifaceted education programs that include enabling and reinforcing techniques can result in positive outcomes for patients.2

Consider liaising with Dementia Training AustraliaDementia Support Australia and Dementia Australia.

Consider developing initiatives such as recruiting cognitive champions who can reinforce education, offer peer support to help clinicians improve their skills and confidence, and organise relevant resources for their wards.3

Consider implementing evidence-based programs, such as TOP 5, that assist clinicians and carers to work together to reduce a person’s distress. Well-structured and well-supported volunteer programs and modification of the environment (see Action 1.29) can also help to reduce a person’s distress.

Day Procedure Services

Pre-admission screening should identify patients with cognitive impairment or at risk of delirium, to trigger strategies to keep the patient safe and to minimise potential distress.

If the day procedure service admits patients who have cognitive impairment or are identified as being at risk of developing delirium, the service should have processes to ensure that clinicians are aware of the systems outlined in Action 5.29.

Refer to the hospitals tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

The whole workforce has a role in providing care and creating a person-centred culture. This means that all levels of the workforce need access to continual, targeted education, information and training.

Provide orientation, education and training for the workforce to understand their individual roles, responsibilities and accountabilities in working with patients, carers and families to prevent and reduce the risk of harm for people with cognitive impairment or at risk of developing delirium.

Include information about forms of cognitive impairment other than dementia and delirium, because people with other forms of cognitive impairment also have poor experiences.1

Consider liaising with Dementia Training AustraliaDementia Support Australia and Dementia Australia.

Consider developing initiatives such as recruiting cognitive champions who can reinforce education, offer peer support to help clinicians improve their skills and confidence, and organise relevant resources for their wards.3

Consider implementing evidence-based programs, such as TOP 5, that assist clinicians and carers to work together to reduce a person’s distress. Well-structured and well-supported volunteer programs and modification of the environment (see Action 1.29) can also help to reduce a person’s distress.

References

  1. Iacono T, Bigby C, Unsworth C, Douglas J, Fitzpatrick P. A systematic review of hospital experiences of people with intellectual disability. BMC Health Serv Res 2014;14:505.
  2. Wand A. Evaluating the effectiveness of educational interventions to prevent delirium. Australas J Ageing 2011 Dec;30(4):175–85.
  3. Graham F. A new frontier. J Nurs Admin 2015;45(12):589–91.