The second stage of the Improving Care for Older People (ICOP) program operated in Victoria from 2010 to 2013. Across Victoria, 35 public health services participated in the initiative, including all metropolitan health services. As part of the program, they were required to undertake initiatives to minimise the risk of functional decline in older patients and improve the provision of care in four areas:

  • Evidence-based environmental improvements
  • Organisation-wide policy development that provides a framework for improving care for older people across the organisation
  • Embedding the evidence base contained within The Toolkit to inform models of care to minimise functional decline for older people, with a focus on acute settings
  • Professional development activities to support workforce capacity building to better respond to the needs of older people in hospital settings

Outlined is a snapshot of the types of initiatives taken by health services relating to cognition.

Health Service

Requirement Addressed and Project Summary

Austin Health

Models of Care – Implementation of Admission and Risk Assessment Tool – includes delirium screen for all patients on admission – where there was a wide uptake

Professional Development – ‘Dementia, Delirium and Depression in the older person’ study days were provided

Bendigo Health

Policy Development - Redeveloped policy on Management of Wandering Behaviours in Cognitively Impaired People

Professional development - Cognition consultant position – provision of education to 3000 staff (2011-13) across Bendigo Health and to health services throughout region

Castlemaine Health

Models of Care - Use of cognitive identifier on patient board

Echuca Regional Health

Models of Care - Cognition Assessment on admission; established Memory Clinic (part of Speech Pathology)

Professional Development - Training provided on dementia, delirium and depression

Goulburn Valley Health

Environmental Improvements – Introduction of date, day, month and time analogue clocks, automatic doors

Latrobe Regional Hospital

Policy Development - Inpatient delirium screening and management policy implemented

Models of Care – Delirium Care Pathway was introduced

- Introduced common process for screening of cognition and also management of patients across LRH; established Cognitive, Dementia and Memory Service (CDMAS)

Peninsula Health

Policy Development – Development of clinical practice guidelines for prevention and management of Delirium

Models of Care - Large piece of work in the area of reviewing delirium management practices - linked to Standard 9 of the National Safety and Quality Health Service Standards (NSQHSS): Recognising and responding to clinical deterioration

Professional Development – Education on delirium and new guidelines using catchphrase ‘Spot it, flag it, treat it, stop it’; delirium champions on each ward/clinical area; extensive education program and internal publicity

South West Healthcare

Models of Care – An Aged Behaviour Cognition nurse role was introduced – to provide support to staff caring for patients with delirium and/or dementia via education; developing care strategies and documentation; introduction of cognition risk screen and behaviour chart trialled and rolled out

Professional Development - Developed cognition and delirium e-learning packages internally

St Vincent’s Hospital Melbourne

Models of Care - Medical file audit of patients with dementia which lead to an audit to gauge prevalence of delirium; review of Code Greys and usage of one-to-one nursing; exploration of relationship between fractured neck of femur and delirium.

- Development & implementation of the ‘all about me’ personal patient profile

- Review of cognitive assessment tools, trial of the cognitive identifier

- Medical file audit of patients with dementia which lead to an audit to gauge prevalence of delirium; review of Code Greys & usage of one-to-one nursing; exploration of relationship between fractured neck of femur and delirium.

Stawell Regional Health

Policy Development - Improving Care for Older People (ICOP) principles incorporated into Cognitive Impairment Policy

Models of Care– Cognitive screening tool embedded in admission assessment process and ward handover procedure; Cognitive Impairment Identifier use was embedded; ward champions identified; policy and use of screening tools part of staff orientation

Professional Development - Cognitive Impairment Identifier training for nursing staff; ward champions system in use; education for Visiting Medical Officers (VMO’s)

Swan Hill District Health

Policy Development – Cognition screen included in admission and risk assessment tool

Professional Development - Nurse education on difference between dementia and delirium; two education days held on Dementia, Delirium and Depression – 48 staff attended plus 6 from external organisations

Werribee Mercy

Policy Development – Development of clinical practice guidelines including for Delirium

Western District Health Service

Policy Development - Cognitive Impairment policy reviewed and redeveloped to reflect ICOP principles

- Delirium policy reviewed and redeveloped to reflect Improving Care for Older Persons (ICOP) principles

Models of Care - Brochures developed and distributed based on redeveloped guidelines including delirium

Western Health

Policy Development– Cognition Advisory committee established and continuing

Professional Development - Engaged volunteers in establishing the Time To Talk (TTT) program and to complete the ‘about me’ tool for patients with dementia, delirium or cognitive impairment