Royal North Shore Hospital is committed to person-centred care
Royal North Shore Hospital is committed to providing person-centred care for all patients, especially those who are cognitively impaired.
Strategies that made a difference
Royal North Shore Hospital has implemented a number of policies, procedures and guidelines, along with assessment tools, services, and education to support the Caring for Cognitive Impairment campaign, including:
- Delirium – Pharmacological Management in Older Patients Guideline
- Delirium in Older People – Clinical Practice Guidelines
- Restraints: Assessment and Alternative to Use in the Acute Care Setting Guidelines
- Management of the Severely Agitated Older Person: Behavioural Emergency in the Elderly Guidelines
- Cognitive Impairment Clinical Practice Guidelines
- The Six Item Screener Tool
- The Delirium Risk Assessment Tool; and
- Directions for appropriate use of bedrails for adult inpatients
- Implementation of a carer support service to support patients, their families and carers during hospitalisation and after discharge
- Implementation of regular staff Dementia Experiential Workshops to enhance understanding of patients with dementia
- A dedicated aged care clinical nurse consultant to assist patients displaying cognitive impairment issues
- Implementation of a Communication and Care Cues (CCC) form to support a more comfortable environment for patients where possible. The form is completed by the family or carer of the patient and outlines specific details that staff should know, including things that may be unsettling the patient.
- The Dementia Experiential Workshops have consistently received positive feedback from staff.
- Anecdotally, staff awareness of identifying delirium has increased.
- The CCC has been useful in facilitating appropriate treatment and care.
- The carer support service has been well received by families and carers, particularly having the option to stay overnight in the hospital using the dedicated recliners and the option to order meals.
Issues and problems faced?
- Cognitive care is an ongoing challenge, requiring ongoing staff education and support. Challenges arise if staff do not have the relevant education or experience to deal with patients who are cognitively impaired, resulting in the patient’s behaviour escalating due to unmet needs.
- Recognising the importance of the CCC and ensuring it is used with all patients aged 65 and over, who are at risk of, or who have cognitive impairment. This can be a challenge in a busy hospital, where paperwork is not always a priority. The workshops and in-services help raise and maintain awareness of the CCC with staff.
Where to from here?
Maintaining a high profile of caring for patients with cognitive impairment is a continued priority and focus. Royal North Shore Hospital is committed to the Caring for Cognitive Impairment and keeping staff informed of the resources available to them and encouraging them to make use of the campaign, especially the CCC.
Plans are in place to implement Caring for Confused Hospitalised Older Persons (CHOPs), an initiative from the Agency for Clinical Innovation Aged Care Network.
Helpful hints for others
Keep staff well informed about cognitive care initiatives and have an expert available to provide assistance, both practical and educational, on a frequent basis.