What is "Delirium"?
Delirium is an acute, often fluctuating change in mental status, characterised by confusion, disorientation, and a disturbance in attention and awareness. Unlike dementia, which is gradual, delirium develops rapidly and is usually temporary.
What is "Cognitive Impairments"?
Cognitive impairments can include conditions like mild cognitive impairment, post-operative cognitive dysfunction, and impairments due to neurological or psychiatric illnesses. They affect memory, attention, and problem-solving skills.
The Importance of Managing Delirium and Other Cognitive Impairments
Delirium and cognitive impairments significantly impact patient health and healthcare outcomes. Delirium, often underdiagnosed, affects a considerable portion of hospitalised older patients, with occurrence rates ranging from 14–56% and hospital mortality rates between 25–33%. Patients with delirium have significantly higher ICU and hospital lengths of stay and associated costs compared to those without delirium. This condition has been linked to adverse short-term outcomes, including up to threefold increases in hospital mortality and length of stay, and long-term consequences like functional disability, cognitive impairment, and dementia after discharge
| Impact Factor | Data Point |
|---|---|
| Hospital Stay Length | Up to 3 times longer for patients with delirium (Dziegielewski, et.al 2021) |
| Healthcare Costs | Significantly higher for patients with delirium (Dziegielewski, et.al 2021) |
| Mortality Rate | Increased by 25-33% in older adults (Leslie DL, Inouye SK, 2011) |
What is the "Managing Delirium and Other Cognitive Impairments" Training Requirement?
Staff in healthcare settings need training to identify, assess, and manage delirium and cognitive impairments. This is crucial for complying with the NSQHS and Aged Care Standards, ensuring patients receive safe and effective care.
Relevant Standards
Systems are in place for caring for patients with cognitive impairment or at risk of developing delirium by:
- Incorporating best-practice strategies for early recognition, prevention, treatment and management of cognitive impairment in the care plan (including the Delirium Clinical Care Standard where relevant)
- Utilising best-practice to manage the use of antipsychotics and other psychoactive medicines
Clinicians providing care to patients with cognitive impairment or are at risk of developing delirium use the system to:
- Identify, prevent, manage and treat cognitive impairment
- Collaborate with carers, families, and patients to implement individualised strategies with the aim of minimising anxiety or distress while receiving care
National Safety and Quality Health Service (NSQHS) Standards
Effective management of high impact or high-prevalence risks associated with the care of each consumer.
Action 5.6.1: Care of client with delirium, dementia, and other cognitive impairment:
The provider identifies and responds to the complexity in the provision of clinical care needs of people with delirium, dementia and other forms of cognitive impairment that includes but is not limited to:
- a. identifying and mitigating the increased clinical risks
- b. delivering increased care requirements
- c. being alert to deterioration and underlying contributing clinical factors.
Action 5.7.4: Implementing end of life care processes:
The provider implements processes in the last days of life to:
- d. recognise and respond to delirium
Strengthened Quality Standards framework analysis - Aged Care Quality Standards
Failure to comply with the requirements could lead to an organisation being penalised or reprimanded.
Related Training Requirements Guides
The following Training Requirement guides can be used to support and facilitate the delirium and cognitive impairment management training requirement:
What Skills Do Staff Need for Managing Delirium and Cognitive Impairments?
Healthcare professionals must develop a range of skills to effectively manage delirium and cognitive impairments. These skills include:
- Early Detection: Recognising early signs of delirium and cognitive changes.
- Communication: Using clear, simple language and non-verbal cues.
- Behavioural Management: Implementing non-pharmacological interventions to manage agitation or aggression.
- Environmental Modification: Creating a safe, familiar environment to reduce confusion and falls.
- Individualised Care: Tailoring care plans based on each patient's history and current needs.
- Family Engagement: Involving family members in care and decision-making processes.
How to Assess Staff Competency in Preventing and Managing Delirium and Other Cognitive Impairments
To ensure staff are competent in managing these conditions, various assessment methods can be employed:
- Practical Evaluations: Real-life scenario simulations.
- Knowledge Tests: Written or online quizzes covering key concepts.
- Direct Observation: Supervisors evaluating patient interactions.
- Feedback Mechanisms: Regular reviews and updates on performance.
- Continuing Education: Requirement for ongoing training and certifications.
Strategies to Support Healthcare Staff Develop Skills in Preventing and Managing Delirium and Other Cognitive Impairment
Organisations can support staff in developing these skills through:
| Strategy | Description |
|---|---|
| Regular Training Workshops | Covering theory and practical aspects. |
| Simulation Exercises | Hands-on experience with mock scenarios. |
| Mentorship Programs | Pairing inexperienced staff with seasoned mentors. |
| Access to Resources | Providing up-to-date research, guidelines, and toolkits. |
| Feedback and Evaluation | Continuous performance evaluation and constructive feedback. |
| Collaboration Opportunities | Encouraging interdisciplinary teamwork and learning. |
Sample Training Plan for the Preventing and Managing Delirium and Other Cognitive Impairments Requirement
The ability of staff to prevent and manage delirium and other cognitive impairments is extremely important to all aspects of healthcare.
Using the above needs assessment survey as an example - The skill needed for effective delirium and cognitive impairment care that requires the most attention is early detection. We can target learning initiatives to fill these gaps to enhance staff competency.
| Quarter | Topics | Resources |
|---|---|---|
| Q1 | Early detection |
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Staff Competency Assessment for Preventing and Managing Delirium and Other Cognitive Impairments - Example
Consider the following survey questions to evaluate delirium management and prevention skills:
Staff Survey - Preventing and Managing Delirium and Other Cognitive Impairments Competency
-
How would you differentiate delirium from dementia in a patient?
- [Answer here]
-
What initial steps would you take if you suspect a patient is experiencing delirium?
- [Answer here]
-
Describe your approach to communicating with a cognitively impaired patient.
- [Answer here]
-
What strategies would you employ to support a patient with cognitive impairments?
- [Answer here]
-
How do you keep up-to-date with best practices in managing delirium and cognitive impairments?
- [Answer here]
Conclusion
Effective management of delirium and cognitive impairments is essential in healthcare, particularly in aged and disability care. Adherence to NSQHS and Aged Care Standards through proper training and assessment of staff competency plays a vital role in providing high-quality care.
References
- Claudia Dziegielewski,Charlenn Skead, Toros Canturk, Colleen Webber, Shannon M. Fernando, Laura H. Thompson, Madison Foster, Vanja Ristovic, Peter G. Lawlor, Dipayan Chaudhuri, Chintan Dave, Brent Herritt, Shirley H. Bush, Salmaan Kanji, Peter Tanuseputro, Kednapa Thavorn, Erin Rosenberg, and Kwadwo Kyeremanteng. Delirium and Associated Length of Stay and Costs in Critically Ill Patients. Hindawi - Critical Care Research and Practice. https://www.hindawi.com/journals/ccrp/2021/6612187/
- Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc. 2011 Nov;59 Suppl 2(Suppl 2):S241-3. doi: 10.1111/j.1532-5415.2011.03671.x. PMID: 22091567; PMCID: PMC3415302.
- Australian Commission on Safety and Quality in Health Care, 2023. 'NSQHS - Comprehensive Care Standard'
- Australian Commission on Safety and Quality in Health Care, 2023. 'NSQHS Action 5.29'
- Australian Commission on Safety and Quality in Health Care, 2023. 'NSQHS Action 5.30'
- Aged Care Quality and Safety Commission, 2023. 'Standard 3. Personal care and clinical care'
- Aged Care Quality and Safety Commission, 2023. 'Requirement 3.3 (b)'
- Aged Care Quality and Safety Commission, 2023. 'Stronger Standards, Better Aged Care Program - Action 5.6.1'
- Aged Care Quality and Safety Commission, 2023. 'Stronger Standards, Better Aged Care Program - Action 5.7.4 - (d)'
