The Cabrini journey to improving the care of patients with cognitive impairment
Cabrini, a private, not-for-profit network of four hospitals in metropolitan Melbourne has actively led strategies to improve management of cognitive impairment. These include developing a committee responsible for driving improvements in cognitive impairment care in hospitals and trialling a Dementia Care in Hospital Program.
Cabrini’s journey to improving the management of cognitive impairment was initiated in response to an increasingly complex demographic of patients in the hospital system. In early 2016, components of cognition were incorporated into ward bedside audits, a significant and valuable effort in capturing compliance against existing policy and procedures. In May 2016, the Cognition, Managing Challenging Behaviour, and Self-Harm Committee was established to build on this work, dedicated to drive changes in improving the care of patients with cognitive impairment.
Issues and problems faced
- Resource limitations including ever-changing staff practices, staff turnover and knowledge retention
- Consistent screening, and identification of cognitive impairment, including staff knowledge and skills in managing complex patients with cognitive impairment
- Clear guidance of clinician responsibilities and referrals for multidisciplinary teams around cognitive impairment.
Strategies that made a difference
- Commitment and support from the hospital executive team and senior level management
- Establishment of a committee with content expertise and operational input to oversee and drive changes
- Consultations with departments and disciplines involved for support and commitment
- Continuous support and education at the ward level.
Tips for others
- Ensure proposed changes or projects are well consulted
- Ensure proposed changes are communicated well and widely
- Commitment of support from senior management or the sponsor of a hospital executive
- Continuous support and education on the ward level
- Implementation of the Plan, Do, Study, Act cycle – important to monitor, evaluate, and make necessary changes.
- The Dementia Care in Hospital Program trial in 2015 was a success and Cabrini is currently evaluating a plan to implement this program in all of its hospital sites
- A revision of cognition policy, protocol, and procedures to show clearer responsibilities and expectations from staff in the care of patients with cognitive impairment
- The Cognition, Managing Challenging Behaviour, and Self-Harm Committee was instrumental in driving change and momentum and coordinating ideas and feedback
- Cabrini is currently exploring the local champion model in up-skilling its workforce to further improve the care of people with cognitive impairment. This has included nurses participating in an online University of Tasmania course on understanding dementia.