Ballarat Health Services

Our Initiatives

In 2001, Ballarat Health Services (BHS) asked the question facing so many acute health services “How do we improve the hospital experience for patients with cognitive impairment and their carers?”

As a result BHS appointed Australia’s first Clinical Nurse Consultant Cognition, with the following aims:

  • Improve the quality and outcomes of care for people with cognitive impairment admitted to BHS acute and sub-acute sites
  • Educate hospital staff on the identification, risk factors and management of cognitive impairment
  • Provide clinical expertise and consultancy
  • Develop a delirium risk management strategy
  • Develop a system of carer support and advocacy
  • Develop a cognition pathway
  • Ensure optimal discharge planning and follow-up
  • Policies and procedures local governance delirium, dementia, cognitive screening
  • The development of consumer approved information for patients and families in relation to delirium, dementia, the Dementia Care in Hospitals Program and the Cognitive Impairment Identifier (CII).

In 2004 The Department of Human Services Aged Care Branch, in collaboration with the Nurse Policy Unit, and Continuing Care and Clinical Services Unit, sponsored four projects on dementia-friendly care in hospitals across the state. The project had overall goals of (i) promoting an acute service environment that would be responsive to the needs of people with dementia, their families and carers, and (ii) facilitating continuity of care between service providers of people with dementia.

The Dementia Care in Hospitals Program (DCHP) is the model of care developed through this initiative. The aim of the DCHP is to assist health services to better meet the needs of patients with cognitive impairment and their carers, Rigorous external evaluation of this model of care demonstrates significant improvements in the hospital care experience for patients with cognitive impairment and their carers.

In 2014 the Commonwealth Department of Social Services (DSS) supported a grants application for the DCHP to be further rolled out at the national level. The National DCHP is governed by the National Advisory Team as a partnership between Ballarat Health Services and Alzheimer’s Australia.  The project is supported by a National Stakeholder Advisory Team.

The national roll-out takes the Ballarat Health Services DCHP model used across Victoria to four interstate partner hospitals:

Outcomes

A hospital wide approach to education and the use of a bedside identifier for cognitive impairment improves staff’s awareness of cognitive impairment and their responsiveness to patients with memory and thinking difficulties and their carers. The program was highly commended at the inaugural Victorian Public Healthcare Awards 2005 and is now embedded into hospital practice.

Since its inception BHS has worked with over 22 public health care services including both regional and metropolitan services to successfully adopt this model of care.

In 2013 with the support of a BUPA Health Foundation Grant the DCHP was re-evaluated in the private sector with the aim of establishing its transferability and to measure additional impacts of the program on patient risks.

The DCHP gained increased support at the national level in partnership with Dementia Australia through the National Consumers Forum which also called for use of a cognitive impairment identifier in acute hospitals.

Where to from here?

  • Each partner hospital is supporting implementation the DCHP through development of relevant governance, structures, policies and protocols. An essential component of which is an embedded cognitive pathway which commences with screening for cognitive impairment in patients aged 65 years and over and 45 years and over for ATSI, and training of relevant clinical and non-clinical staff
  • The Commonwealth DSS has agreed to fund evaluation of the national DCHP. An independent evaluation will be undertaken by Deakin University and a final report will incorporate other evaluation contributions
  • Partner organisations will become leaders in their jurisdictions for further growth and spread of the DCHP
  • Evaluation of the national DCHP will guide further work at both a local, state and national level in the area with insights into staff, patient and carer outcomes; project process; clinical adverse events and cost
  • Further improvements in BHS models of care to be guided by the national standards.

Other initiatives  

Ballarat Health Services was appointed as lead agency to identify and develop resources within the Dementia domain of the ‘Best Care for older people everywhere- the Toolkit 2012’ as part of the Victorian implementation of the Council of Australian Governments Long Stay Older Patients (COAG LSOP) initiative. Ballarat Health services recently contributed to and reviewed the Dementia clinical topic as part of an updated resource now called Older People in Hospital; set to be re-launched in February 2016.

Other Ballarat Health Services activity/membership in relation to Cognitive Impairment:

  • Membership of the Ministers Dementia Advisory Group
  • Membership of the Cognitive Impairment Advisory Group- National standards
  • Presentations as representatives of BHS @ local, National and International conference and meetings
  • Facilitation of information sessions @ the local Alzheimer’s Australia Living with Memory Loss programs
  • Cognition CNC liaison between BHS, local General Practitioners and other primary and community care networks
  • Facilitation of GP Practice Nurse education -cognitive assessment
  • Graduate Nurse transition program mentoring

Challenges

  • Increasing service need and requirement to respond to increasing prevalence of CI within the hospital (acute care) environment
  • Workforce recruitment and retention rates and the flow on effect including timely provision of education relating to cognitive impairment (delirium and dementia), use and interpretation of screening assessment tools and the Dementia care in Hospitals Program for both new and existing staff (both clinical and non-clinical)
  • Succession planning and service growth for the Cognition Clinical Nurse Consultant role within BHS
  • Competing organisational and ward based priorities
  • Adequate staff resourcing and skill mix
  • Physical environments which currently exist were not designed to best meet the needs of patients with CI and their carers
  • Maintenance of existing programs and initiatives whilst building on existing infrastructure
  • Sustained individual and organisational commitment to best practice and improving the hospital experience for patients with cognitive impairment and their carers
  • Maintaining a dementia friendly culture within the organisation and and the use of dementia friendly language.

Helpful hints for others

Active executive support is vital to achieving culture change.

Alignment of proposed, updated or new hospital policies/models of care with relevant National standards will assist in their implementation.

It is essential to maintain evidence based operational protocols, clinical practice guidelines and policies to support associated models of care.

Acute hospitals must develop systems which encourage and foster better engagement with primary care (and other supportive organisations). This will ensure ease of transfer of information and further support continuity of care both at admission and discharge.