Care And Management Policy For Delirium In Older Australians

Increasing Delirium in Older Australians in Healthcare Centers

Discuss about the Policy Critic and Policy Document.

The Australian older population admitted to hospitals is increasing greatly, more than 1 million individuals obtain age healthcare services and this is thought to increase to above 3.5 million by 2050. The aged care staff which comprises the assistant nurses and nurses are required to meet this requirement, for this reason, the aged care staff has adopted a policy to ensure safe and quality healthcare provision (Twigg et al 2010).

However, this policy require various updates to enable its effectiveness, therefore, the care and management policy for the older people at the risk of delirium is created as an update of the policy for the care and management of the elderly. Delirium refers to the severe change in the attention and awareness of the patients this condition is costly, common, and morbid for the healthcare organizations and the patient. The hyperactive delirium is identified easily and it is very common among patients it also has a high mortality rate. Delirium is said to be common among the older Australian individuals who have been hospitalized to the acute healthcare centers (Page and Ely 2015). At admission, the occurrence rates of delirium are 10% to 31% and 3% to 29% during the admission in healing inpatients and significantly higher rates of 47% to 53% have been found in older individuals admitted for hip fracture and cardiac surgery, rates of above 80% have been identified in older individuals hospitalized at the ICU (intensive care unit).  Delirium has severe consequences, which include increased costs of hospitalization, increased mortality, and morbidity, increased potential for admission to the institutional care systems and increased admission periods (Pandharipande et al 2013).

To improve the present procedure and policy for care and management of older people at the risk of delirium, the policy will be revised and restructured in relation to executing the best supporting independent living program by use of assistive technology and the involvement of the elderly as well as their relatives in managing delirium. The objective of this evaluation is to conduct a discussion about the care and management policy for the older people at the risk of delirium and to advance the care and safety of older individuals by executing recommendations from the best clinical guidelines for delirium care. For this reason, a discussion on the current policy was conducted; a literature analysis and research were then conducted about the best assistive technology program and implementation of the policy was done using the action plan and evaluation tools (Schofield, Tolson and Fleming 2012).

Policy Update to Ensure Safe and Quality Care for Delirium Patients

The present policy of care and management of the elderly involves the strategic planning, assessment, and monitoring of the old individuals. A decision medium about risk cases and the management measures these risks are part of the policy. The current method tries to deliver a better understanding of care and management of the elderly provide the care procedure for older individuals; it focuses on the provision of safe and quality care for elderly by enhancing the screening protocols of older patients (Taylor 2005). The care and management policy for the older people involves:

1. An integrated and effective system for supporting the independent living of the elderly
2. Participation of the carers and the older individuals in the care and management protocols
3. Establishment of effective risk assessment tools (for instance, the Fall Assessment Risk Tool and the Delirium assessment risk tool) for the elderly to ensure effective management of various risk factors at the care centers.
4. Establishment of various clinical practice guidelines for the care of the elderly

The new policy however, delivers a distinct structure of delirium assessment upon admission and management of delirium in a standardized manner (Kostas, Zimmerman and Rudolph 2013). The policy guides the healthcare staff members of delirium reassessment, care procedures, and documentation. This has helped in the improvement of the health services towards delirium care; some health facilities have employed cognitive nurses to support and care for the older people at the risk of delirium. With the increase in the rate of the aging population in Australia, there are increased cases of delirium, which require a proactive and systematic approach to the policy, which incorporates assessment, prevention, and management measures (World Health Organization 2001). Considering the current policy, it is vital for its update to ensure safe and quality care for the older individuals in the health facilities. The policy is devoted to the suitable implementation of strategies and plans for quality care provision to delirium patients.  Therefore, to improve the dexterity and flexibility of the policy and ensure quality and safe care for the patients, the policy requires an update with an effective assistive technology program of the older individuals and the involvement of the family members as well as the patients in the care process to avoid potential preventable errors.

To analyze and advance the current policy, various stages of the investigation, dialogue, questionnaire, and amendment were done. This procedure involves:

As a medical expert, all the other specialists need to be aware of the policy’s impacts on the part of the professional practice. The principal activity to advance the present survey is to comprehend the delirium care policy among the carers and the staff members. The investigation covers certain questionnaires associated with the procedures and policy. The questions based greatly on the current policy, the pros and cons of updating the policy, the high quality advancing options and the thoughts of executing an effective policy (Dougherty and Lister 2015).

Assistive Technology and Family Involvement in Delirium Care

Delirium is greatly associated with the older individuals hospitalized at the acute hospitals, this problem is thought to be on a rise in the future as a result of the aging population and the greater probability of admission to hospitals at the older age. Restructuring the evidence-based assessment and intervention, the policy and the clinical guidelines is the key towards the provision of quality and safe care to the delirium patients (Thompson, McCormick and Kagan 2006). From the response of the previous delirium care policy, the parts that require of action are identified and the issues concerning the provision of the carers, the older individuals and their family members with the relevant information on how to ensure management of delirium through the provision of safe and quality care are discussed. The updated policy focuses on the implementation of best supporting independent living (using supportive technology) procedures for delirium and the involvement of the older patients and their families in the management of delirium, therefore, potential errors are avoided this ensures quality and safe care provision for the delirium patients residing at the hospitals.

To improve the policy, discussions are conducted with the consultative team, the; nurse educators, managers, registered nurses, regional managers, directors and clinical nurse advisor are involved in the discussion of making the policy. The crucial facilitators in the development of the policy are the health user groups and the policy developing groups. The process of updating the delirium care policy affects every participant, therefore, their opinion valued thought, and participation is encouraged (Rolls and Elliott 2008). The healthcare staff members involved in the provision of care, carers, family members, the older individuals residing at the care facility and the volunteers are involved in the dialogue for the updating of the delirium care policy. The delirium care policy sponsors, national representatives, specialized expertise, the main associates in the consultation procedure for delirium care policy development and regeneration, the academic staff, researchers as well as members from other organizations such as the Australian and New Zealand Society for Geriatric Medicine are involved in the policy update discussion (World Health Organization 2013).

The essential aspects in developing a policy are; coordination and creation of good relations, that is, coordination with the stakeholders and the health consumers and relationships with policymakers, the experimental knowledge is also vital in this process. The people involved in the development of the updated policy help in the creation of ways to endorse its execution in a strategic manner, while the old policy is amended for the purpose of the new more effective policy (Rondinelli 2013).

Collaborative Approach to Support Independent Living for Delirium Patients

Concerning the matter and the evidence centered practice study; the updated policy is an improvement of the old policy’s opinions. All the segments of healthcare multidisciplinary group approach are needed for healthcare regulation, development of the policy and service education. After the analysis process, the policy’s draft is finalized. The areas of feedback are made clear to endorse intuition into the new intervention and practice (Straus, Tetroe and Graham 2013).

The evaluation and control of delirium are examined in terms of the quality of the results as well as the medical practice that is evidence and research-based. When collecting evidence data (Australian), literature from various sources are searched and analyzed, these sources include; the medical practice guideline of the NHMRC, internet searching using different search devices, the website of territory and state health agencies and departments and the professional websites of organizations and colleges (Britton and RUSSEll 2004). The international study evidence is also revised to learn about the present practice that is evidence-based, the international evidence data is collected from sources like; the UK’s NICE (National Institute for Health and Care Excellence). More literature is collected from PUBMED is used in the discussion about the development and the practice (Siddiqi, House and Holmes 2006).

The increased occurrence of delirium in older people triggers the requirement for an effective care program for these individuals, there is the need for a more collaborative and active approach to ensure quality and safe delirium care provision to the patients (American Psychiatric Association 2013). The aged care housing nurses are required to conduct delirium screening and management approaches when caring for the older individuals who faced by the threat of delirium prevalence, the delirium care procedures and policies are the main aspects affecting care delivery. The degree to which the older individuals are ready to adopt delirium care procedures is assessed; the procedures involve improved screening of delirium in the elderly upon admission, during the admission and at discharge (NICE 2010). The procedures also include the participation of the patients and their families in the provision of the care to enable supportive independent living of the delirium patients. The research indicates that the older individuals are more expected to follow the delirium care procedures. The assistive technology has helped the delirium patients with; communication, safety, and remembrance.  The support of safety and security for delirium patients is the main aspect of the policy, the assistive technology for individuals with delirium is planned to provide support safety and security of the patients, for instance, the motion sensor. The involvement of the patient’s families in the care process enables avoidance of certain errors (Karel, Gatz and Smyer 2012).

The individuals at the risk of delirium are screened using various tools and validation tests this, the process is conducted by highly trained clinicians who are competent in the diagnosis of delirium and in using of the authenticated tools (Clinical Epidemiology and Health Service Evaluation Unit 2015).  In case of communal residence, the elderly are provided with the assistive technology tools to help them with safety maintenance, communication, for instance, conversing with their carers for effective care provision and remembrance tools for reminding the patient on essential aspects such as taking of medications (Gomes 2015).  The review of the involvement in various residential care systems and hospitals is conducted concerning the use of assistive technology as well as the contribution of the patient and their relatives in the provision of care. This study concludes that the use of assistive technology is of vital significance in ensuring independent living of the delirium patients.

The use of assistive technology, as well as the participation of the patients and their families in the care process, ensures improved safety and quality of care delivered to the older individuals at the risk of delirium. Although the process may be costly as it involves use of some advanced devices, it helps improve the day to day activities as well as safe time as the health specialist is able to attend to more than one patient at the same time by use of the health monitoring devices (monitoring of, heart rate, blood sugar and blood pressure with the data being transferred automatically to the health specialist). It is therefore beneficial to apply these assistive devices in the delirium care process of the elderly patients to enable easier and quality care of these individuals (Prince et al 2016).

Policy implementation occurs after the processes of literature review and consultation, for the successful planning and implementation of the policy a strategic action plan is conducted. The proceedings regarding the updated policy and the implementation of the policy are planned and the evaluation tools, as well as the feedback obtained, are used to assess the usefulness of the policy (Sutton 1999). The tool for delirium risk assessment is used to discard the threats associated with the delirium in the older individuals (ACI Aged Health Network 2014). The effective action plan related to delirium screening, diagnosis, prevention, and management are discussed.

In all health care centers, the older individuals undergo a cognitive screening upon admission for delirium risks using various authorized tests and they are viewed in every 2 months by highly trained and experienced clinicians in the diagnosis of delirium during their hospital stay regarding delirium risks (Siddiqi et al 2016).     Delirium diagnosis, care, and management are recognized as the prioritized care activity in most of the healthcare facilities; therefore, effective application of delirium care and management requires a complete approach of evaluation and development of an individual-centered care with the aged individuals.   In the implementation of the delirium care policy, the following factors are considered:

delirium with the authorized tools; the residents are evaluated by a specialized clinician for cognitive impairment upon admission, the risk of pressure injuries and fall are ruled out as the part of evaluation tests for delirium. The residents’ behavior is evaluated and a care plan is developed with the appropriate goal. The Factors affecting delirium are assessed such as fall, depression, environmental factors and medication as well as collaborative working between the health specialists, the patients, and the family members (Zarit and Zarit 2012.).  The assistive technologies involved in the management of delirium are also involved in the implementation process, all approaches associated with delirium care improvement and management are part of the implementation process and the evaluation is re-attended to in every two months.

Task	Resources	Duration	Outcome
Educational conferences	Establish an educational setting to provide information on improvement of the quality care for the older individuals faced by the risk of delirium and management of delirium in older people by the use assistive technology and enhancement of collaborative working.	2 months	Increased awareness on how to effectively manage delirium in older people
Advertisements	Creating placards to promote the use of assistive technology in delirium care for the older patients	2 months	Increased  knowledge about the policy
Assistive technology and collaborative working campaign	Supply of the current policy to every staff member	2 months	Increase skill to deliver quality delirium care and offer a safe environment for older patients with the risk of delirium
data collection and screening	screening identifies delirium in the older individuals and the data collector collects information concerning older people	2months	Increased application of the screening tools and identification of the older individuals with the delirium risk.
Review the occurrence of delirium	event form	2months	Improving the care and management of the delirium patients
Staff investigation, management, and response	Creation of questionnaires, conducting interviews with the residents, staff members and managers, focusing on their response to guarantee adherence and feasibility	2 months	Increased awareness and level of skills in delirium care provision for the elderly, improved attitude towards the policy, acquisition of the feedback of the other members about the  policy

Conclusion

Delirium is greatly associated with the older individuals hospitalized at the acute hospitals, the hyperactive delirium is identified easily and it is very common among patients it also has a high mortality rate, this condition is costly, common and morbid for the healthcare organizations and the patient This problem is thought to be on a rise in the future as a result of the aging Australian population and the greater probability of admission to hospitals at the older age. The creation of the new policy allows the provision of assistive technology for the older individuals at the risk of delirium. The policy has also improved team working in the field of care and health through the emphasis on collaborative working as well as the involvement of the patient in their care process helps avoid some potential errors.  Other essential benefits involve; the enhancement of the neurological functioning by the provision of the reminder devices and the general health improvement as the patients’ conditions such as blood pressure, are monitored automatically (Rudolph and Marcantonio 2011). Older individuals with a history of delirium are helped by the assistive technology for provision of quality and safe care and the study conducted indicates that assistive technology helps the older people conduct their daily activities effectively. The measures concerning the new policy and its application are scheduled and assessment tools (for instance, the delirium risk assessment tool), as well as the responses, are used in the evaluation of the policy’s effectiveness (Gitlin et al 2006).

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