Nowra Private Hospital is an acute 84 bed medical/surgical hospital in the south coast of NSW. The hospital has made a commitment to the Caring for Cognitive Impairment campaign. We have developed a plan of care and implemented care strategies for our patients who may exhibit behaviours of concern. Patients who exhibit behaviours of concern are generally in a confused state, usually associated with delirium and/or dementia. Behaviours of concern require consideration and investigation as patients who exhibit the behaviour may present a health and safety concern for themselves as well as others.
We receive patients from a large geographical area for elective and non-acute trauma surgery. On occasions, there has been reduced time to safely assess the risks of a potential or known delirium or cognitive impairment. This can result in a fragmented plan of care and a higher risk, for the safety of the patient and staff.
Nowra Private Hospital has developed a pathway of care for the management of delirium. Education was presented to our surgeons, anaesthetists, nursing and allied health staff to outline the difficulties faced when cognitive impairment is not managed appropriately. With the support of our geriatrician, we have developed and implemented a strategy to identify and assess delirium or cognitive impairment.
The Abbreviated Mental Test Score (AMTS) is now completed on all orthopaedic patients over 65 when attending our pre-admission anaesthetic clinic, patients who have a known cognitive impairment and those patients who present with a fracture. Early referral to our geriatrician is arranged according to the AMTS and regular assessments and an appropriate medication regime is put in place. We have incorporated a plan for orientation, therapy and involvement of the patient and their family. A multi-disciplinary team approach to their care is coordinated with a view to an earlier admission.
For more information, contact Kerrie Madin on madink@ramsayhealth.com.au.