PRINCIPLE 3: Assessment of older people with confusion

Older people who are confused will be assessed. The cause of their confusion will be investigated to determine the appropriate management.

Quality measures and Expected outcomes

Given the importance of early identification and management of confusion (resulting from dementia or delirium), CHOPs recommend the following quality measures and expected outcomes of implementation of the key principle of assessment of older people with confusion.

Quality measures

System measures	Cognitive assessment Method (CAM) tool available Comprehensive assessment process in place including referral for dementia assessment if necessary Dementia and delirium appropriately coded, coding monitored to reflect activity Carer assessment tool available
Patient measures	Review of care (File Audit) Dementia and/or delirium documented
Carer measures	Carer consulted regarding prior history Carers needs assessed
Staff measures	Knowledge of cause of confusion and distinction between dementia /delirium/ depression Staff able to identify carers Staff able to undertake carer assessment

Expected outcomes

Hospital teams will engage with the person, their carers, their families, local primary care providers, residential care, home care agencies and their GP to gather information to establish the onset and recent history of symptoms of confusion.
Systems / clinical decision support tools are in place for staff which outline a clear process for a comprehensive diagnostic assessment to investigate the cause of confusion.
Systems / clinical decision support tools are in place outlining treatment and referral options for patients who have delirium, undiagnosed dementia or other mental health problems.