The Townsville Hospital and Health Service is caring for cognitive impairment
The Townsville Hospital is the largest facility in the Townsville Hospital and Health Service, and is the region’s only tertiary facility. The hospital serves as the main referral and teaching hospital north of Brisbane, treating patients from as far north as Cape York Peninsula and the Torres Strait Islands, and west to Mount Isa and the Gulf of Carpentaria. The health service also includes six rural hospitals and/or multipurpose hospital facilities, an island hospital and community health service and two residential aged care facilities.
While the residential aged care facilities have dementia-specific units, an increasing number of cognitively impaired patients sit in rural hospitals while awaiting appropriate discharge destination and community services.
Strategies that made a difference
- In 2009, The Townsville Hospital recognised the need for appropriate treatment areas with appropriately trained staff to care for the acutely unwell cognitively impaired patient, with or without a background diagnosis of dementia.
- In 2009, a 13-bed unit with secure entry and exit was commissioned. There is now a 30-bed geriatric unit that specialises in geriatric syndromes, including cognitive impairment. Occupancy of the unit sits at 90-100 %, with the percentage of dementia or delirium patients ranging from 45- 60%.
- In 2013, an educational program was developed and delivered by the Nurse Unit Manager (delirium and dementia unit) on recognition and early intervention and treatment.
- Nursing staff were trained in the use of the Confusion Assessment Measure (CAM) scoring method to identify delirium in patients for admission to the delirium dementia unit for ongoing treatment and assessment. Staff were educated and attuned to caring for people exhibiting an escalation of Behavioural and Psychological Symptoms of Dementia (BPSD).
- A comprehensive observation sheet was developed that could record hourly the behaviours of any patient of concern that would require intervention. On the form, staff record behaviour, agitation, aggression, pain, sleep, location. All of this giving background information on which to base further need for intervention.
- An A3 behaviour chart, incorporating behaviour, sleep, pain and agitation, was developed to further enhance awareness.
- All delirium and dementia patients are reviewed by the geriatric consultant for suitability to the delirium and dementia unit.
- Transfer to suitable discharge destinations is improved, with specialised management of the BPSD.
- Mobility function has increased using the Functional Improvement Measure as a measurement tool.
- No physical restraints are used in the unit.
- The unit does not require the use of nurse safety specials.
- Informal nursing and medical feedback has been 100% positive, with a noticeable improvement on wards of much less disruption to the provision of treatment to other patient groups.
Issues and problems faced?
The first challenge faced was a lack of gerontology medical support, with no gerontologist in the region. Nursing and allied health staff were the driving force, managing with generalist medical support. The introduction of a gerontology service in 2014 was initially limited. 2015-16 has seen a stronger medical workforce, supported by the nursing and allied health teams.
Education was not readily available and needed to be self-directed by staff.
Where to from here?
- A continued focus and recognition of the increase in cognitive impairment across the health service, that impacts not only geriatrics, but increasingly in the younger age group.
- Staff education for medical and nursing, particularly in the early recognition and intervention of delirium and longer ongoing treatment of cognitive impairment to decrease the direct impact on acute services and the potential for premature residential care admission.
- To improve the profile of cognitive impairment and the knowledge base of the care providers, both in acute and residential aged care.
Helpful hints for others
The support of a geriatric specialist and tangible organisational executive commitment and recognition of the need for ongoing services is essential to allow the patient to be the centre of care.
A strong education component across all professional streams must be incorporated as part of any strategy for improvement in service delivery and improved patient outcomes.