Canberra Hospital and Health Services commit to Caring for Cognitive Impairment
Canberra Hospital is an acute care teaching hospital. It has approximately 600 hospital beds and is a tertiary referral centre, which provides a broad range of specialist services to the people of the Australian Capital Territory and South East New South Wales.
Canberra Hospital is the largest public hospital in the region, supporting a population of almost 540 000. It has strong links to community-based services that provide continuity of care for patients.
Strategies that made a difference
As part of its commitment to the Caring for Cognitive Impairment campaign, Canberra Hospital proudly participated in the national rollout and evaluation of the Dementia Care in Hospitals Program (DCHP), led by Ballarat Health Services and supported by Deakin University, Alzheimer’s Australia and the Australian Government.
The DCHP allows for greater awareness of cognitive impairment through:
- Staff education to improve recognition of cognitive impairment
- Encouragement of positive engagement with families and carers
- Use of the cognitive impairment identifier as a bedside alert.
Other initiatives implemented through the DCHP include:
- A nurse practitioner-led memory follow-up clinic, delivered in partnership with Alzheimer’s Australia, ACT
- Environmental audits, extended education on Behavioural and Psychological Symptoms of Dementia (BPSD) and the introduction of doll therapy, where identified patients are provided dolls to care for.
The DCHP has fostered collaboration between the Acute and Subacute Care of the Elderly inpatient units, Alzheimer’s Australia ACT and their Dementia Behaviour Management Advisory Service (DBMAS).
On the nine wards that have implemented the DCHP, patients aged 65 and over are routinely screened for cognitive impairment, using the 4-item Abbreviated Mental Test (AMT4) and a clock drawing test. From October 2015 to September 2016, approximately 2,700 patients were screened, with almost 40% screening positive for cognitive impairment. More than 750 hospital staff from a range of clinical and non-clinical services participated in education sessions on cognitive impairment.
Some comments from staff about the implementation of the DCHP:
“I can now care for patients with a better understanding – it makes nursing the patients easier”, and “The DCHP highlights that delirium is real and is a crisis for the person and their carer.”
“I think the bedside alert is very useful! What a great idea.”
The DCHP has reinforced that cognitive impairment is part of the everyday language of hospital quality and safety, and that better awareness and treatment of cognitive impairment can reduce the risks of preventable adverse incidents, such as falls to patients.
Issues and problems faced?
- Maintaining awareness of cognitive impairment as a quality and safety issue, and delivering education to a large and ever-changing workforce
- Achieving consistently high rates of routine cognitive screening among the other demands on clinical staff. To meet this challenge, support was required from a number of executive levels within the hospital.
Helpful hints for others
- While a focus on cognitive screening is important and necessary, it is critical to translate this knowledge into meaningful change in how patients are cared for
- The Canberra Hospital was able to receive support, share experiences and learn from community partners: Alzheimer’s Australia ACT, Health Care Consumers Association ACT and Carers ACT. The Central Adelaide Local Health Network also provided valuable expertise to the program and its initiatives during a two day educational forum, which focused on reducing distress for people with dementia.
Where to from here?
The Canberra Hospital will:
- Continue the rollout of the DCHP to the remaining acute medical and surgical wards
- Embed and extend staff education
- Continue the aged care units’ initiatives to further improve the quality and safety of care for the most vulnerable patients with BPSD.
The ACT Government is currently building a new subacute facility, the University of Canberra Public Hospital, which will have 140 inpatient beds and 75 day places. The needs of people with cognitive impairment are central to the design of both the physical building and future models of care.
Ongoing effort will be needed to sustain positive changes to organisational culture and clinical practice, and ensure achievement against version 2 of the National Safety and Quality Health Service Standards.