Royal Brisbane and Women’s Hospital (RBWH) is a tertiary referral teaching hospital with 929 beds, located at the Metro North Hospital and Health Service (MNHHS) Herston site, close to the Brisbane CBD. They describe here their initiatives, the challenges faced and the outcomes in caring for cognitive impairment.
We have a comprehensive set of principles for managing patients with cognitive impairment that has been endorsed by our MNHHS. This forms the strategic framework for care of cognitively impaired patients within our acute facility.
Eat Walk Engage (EWE) is a multi-component, multi-disciplinary delirium prevention program that has been implemented in eight acute wards (across medical, vascular surgery, oncology, orthopaedics and general surgery) at RBWH.
EWE has been developed using a novel, multi-professional allied health assistant role that supports allied health professionals and nursing staff deliver the interventions to at-risk patients. The program has a strong focus on sustainability, consumer engagement and research partnerships.
There are two new specialist nurse positions currently being funded until 30 June 2016:
Agreement was reached across all MetroNorth acute hospitals to use a single screening tool for cognitive impairment. The 4AT was chosen based on experience at a number of other sites.
An independent pilot study at the RBWH comparing the 4AT to a number of other screening tools confirmed that nursing staff found the 4AT to be the easiest to administer.
The 4AT is now included in the newly revised RBWH patient risk assessment tool, linked to actions when confusion is identified, and will be used for admission screening for cognitive impairment in the emergency department and elective admissions.
Earlier this year, Professor Richard Fleming from the NSW/ACT Dementia Training Study Centre was invited to conduct a workshop on the evidence and design principles for a supportive hospital environment for people with dementia.
As a result of this workshop and the issues highlighted from ward environmental audits, a multi-disciplinary group was formed to establish a systematic and coordinated process to improve our hospital environment. This ensures that design principles are being included in ward refurbishments and that wards are supported to make changes to their environment with minimal cost.
Learn more about other hospitals that have signed up to the campaign here.