Ballarat Health Services
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 Cognition Clinical Nurse Consultant.
Strategies that made a difference
BHS’s Cognition Clinical Nurse Consultant was established with the following aims:
- Improve quality and outcomes of care for people with cognitive impairment admitted to BHS acute and subacute 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
- Develop consumer approved information for patients and families in relation to dementia and delirium, known as the Dementia Care in Hospitals Program and the Cognitive Impairment Identifier.
In 2004, The Department of Human Services Aged Care Branch, in collaboration with other units in BHS, sponsored four projects targeted at improving dementia-friendly care in hospitals across the state. This led to the creation of the Dementia Care in Hospitals Program (DCHP), its aim being to assist health services to better meet the needs of patients with cognitive impairment, and their carers.
Based on the success of the DCHP, the Commonwealth Department of Social Services supported a grants application for the DCHP to be 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 program is supported by a National Stakeholder Advisory Team.
Since its inception, BHS has worked with over 22 public health care services, including both regional and metropolitan services, to successfully adopt the DCHP. The DCHP is supported at a national level in partnership with Alzheimer’s Australia through the national Consumers Health Forum, which also called for use of a cognitive impairment identifier in acute hospitals.
A hospital-wide approach to education and the use of a bedside identifier for cognitive impairment improves staffs 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.
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.
Further BHS work in relation to cognitive impairment has included:
- The establishment of a lead agency to identify and develop resources for 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 initiative
- A review of the Dementia clinical topic as part of an updated resource now called Older People in Hospital
- Membership of the Ministers’ Dementia Advisory Group
- Membership of the Cognitive Impairment Advisory Group – national standards
- Presentations at local, national and international conferences and meetings
- Facilitation of information sessions at local Alzheimers Australia-run programs
- Facilitation of GP Practice Nurse education – cognitive assessment
- Graduate Nurse transition program mentoring.
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.