PRINCIPLE 4: Management of older people with confusion

NSW hospitals will have programs in place for older people with confusion that align with these principles. The implementation will be in partnership with the older person, their carer and family.

Quality measures and Expected outcomes

Multifactorial prevention strategies have the potential to reduce the incidence, duration and severity of delirium (1). Patient-centred care can lead to improvements in health care quality and outcomes by increasing safety, cost effectiveness and patient, carer/ family and staff satisfaction (2, 3).

CHOPs recommend the following quality measures and expected outcomes of implementation of the key principle of management of older people with confusion.

Quality measures

System measures	Policies, procedures, guidelines, referral pathways and/or protocols in place
Patient measures	Number of ward moves for patients Use of antipsychotics Complication rates - falls, pressure injury Length of stay, mortality
Carer measures	Carer consulted about their role in management Carer involved in the development of a management plan
Staff measures	Referrals to specialist services for confusion and underlying causes Increase in staff knowledge

Expected outcomes

Hospital teams implementing the CHOPS program will have a sound understanding on how to recognise the causes of confusion and subsequent management of confusion (a standardised assessment process should be clearly outlined which includes the specific history, examination and investigations to be undertaken for the management of confusion).
Hospital teams will have a clear understanding of how to manage the symptoms of confusion for patients through the implementation of best practice (strategies will be developed locally and may include specific actions as listed below).
Care planning will be individualised to the needs of the confused older person and responsive to their needs in relation to nutrition, hydration, comfort, activity and communication. This care will be assessed, planned, implemented and reviewed by nursing and medical staff collaboratively.
The needs of carer and family members will be recognised and they will be consulted about their role in the plan of care.
Localised ‘Getting to Know You’ profiles and supporting systems will be implemented by the ward nursing staff to engage with the carers and families to gain information that can be used to personalise the care given by all hospital staff.
Confused older people will be engaged in meaningful activities relating to their interests and abilities. The activities should encourage recovery and maintenance of function, and social engagement should be developed in partnership with the patient’s family and carers when appropriate.

References

Australian Health Ministers Advisory Council [AHMAC]. Delirium Care Pathways Canberra: AHMAC, 2011.
Australian Commission on Safety and Quality in Health Care. Evidence for the safety and quality issues associated with the care of patients with cognitive impairment in acute care settings: a rapid review. Sydney: 2013.
Australian Commission on Safety and Quality in Health Care. Handbook for improving safety and providing high quality care for people with cognitive impairment in acute care: A consultation paper. Sydney: 2013.