Port Pirie Regional Health Service dramatically increases its consumer engagement

The Port Pirie Regional Health Service is a regional facility in South Australia, situated 250 kilometres north of Adelaide that provides a range of acute, aged care and community services to an ageing population.

As part of its commitment to the Caring for Cognitive Impairment Campaign, the Port Pirie Regional Health Service was the first major country hospital to implement the Country Health South Australia’s Comprehensive Care of Older People model of care project.

Strategies that made a difference

The hospital developed a diverse working group, which began project planning in September 2018, establishing five key priority areas:

1. Optimising care in the emergency department and reducing unnecessary presentations
2. Improving the care of older people with cognitive impairment  – preventing delirium and managing cognitive impairment
3. Implementing the ‘You Are Leaving Hospital’ model – a take home document for patients
4. Improving the discharge summary process and availability of timely, relevant and accurate data
5. Collection and dissemination of timely, relevant and accurate performance data to the teams providing care through the use of key performance indicators.

The hospital implemented the model of care which included 4AT screening assessments, cognitive impairment identifiers and behaviour assessment charts. Resource folders were embedded in the emergency department and acute wards. An extensive education process was provided for all clinical and non-clinical staff to ensure a consistent approach to project deliverables, staff expectations and responsibilities.

A very successful collaborative launch of the project in November 2018 included members from the local dementia support group and external guest speakers, who provided real patient stories and experiences.

The hospital continued to implement further strategies in 2019, including:

• upgrading the inpatient multidisciplinary whiteboards to include a column for cognitive impairment (using the CII smbol), which triggers a high priority pharmacy review and medication reconciliation
• engaging Dementia Australia to undertake environmental audits of the residential aged care facility and acute wards. The reports from these audits will inform the hospital’s action plan on improving the physical environment that will also include direct consumer input.
• Engaging consumers using a feedback survey to inform areas for ongoing improvement.

Outcomes

• positive improvement in the appropriate use of 4AT screening assessments, cognitive impairment identifiers and the behaviour assessment charts, demonstrated through a series of point prevalence audits
• staff interest in and uptake of new work practices
• a dramatic increase in the level of engagement between staff and patients and families that is sustained and growing
• staff initiated consumer surveys to identify how to improve care and regular consumer-driven contributions to individual journey boards
• a reduction in incidents of delirium as a hospital acquired complication (HAC): prior to the project implementation in November 2018, delirium was the health service’s highest reported HAC; post-November 2018, there have been no delirium HACS recorded.

Based on average increased length of stay for patients that experience a hospital acquired delirium, combined with national average costs per admitted day, the service has calculated it is potentially saving $27,791 for each HAC delirium that is prevented. When averaged over the past three years, this is a projected saving of approximately $230,665 per year in HAC penalties and associated Occupied Bed Days (OBD) costs.

Helpful hints to others

• commitment to an ongoing project lead and nursing officer to maintain staff awareness, provide ongoing education, and promote caring for cognitive impairment. These positions will work closely with the comprehensive care working group
• investment of time and resources into a comprehensive staff education package, which has enabled staff to be identified as ongoing leads and champions
• early and ongoing engagement with local community members and support groups that has provided the opportunity to hear real-life stories and experiences. This has enhanced the service’s ability to provide an individualised patient and family-centred approach to cognitive impairment care delivery and has been extremely valuable in shaping some project goals
• weekly/fortnightly staff newsletters to keep staff up to date, maintain focus on the project for an extended period and to empower staff to be a part of the change management process.

Where to from here

The Port Pirie Regional Health Service comprehensive Care of the Older Persons Working Party will be engaging community members, support groups and aged care facilities to develop a ‘My Top 5’ program. The aim is to improve the service’s ability to provide individualised care to patients and provide comfort to family members about the care their loved one is receiving.