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PRINCIPLE 1: Cognitive screening

Patients aged 65 years and over will be screened for confusion on admission or within 24 hours of admission using a validated screening tool.

Quality measures and Expected outcomes

Australian guidelines for the management of delirium in older people recommend that a structured process for screening and diagnosis of delirium should be established in all healthcare settings given the prevalence of cognitive impairment among older patients in hospital (1).

CHOPs recommends the following quality measures and expected outcomes of implementation of cognitive screening.

Quality measures

System measures

Agreed cognitive screening tool is available for staff

Patient measures

Older people aged 65 years and over who have received cognitive screening on admission or within 24 hours (total and percentage)

Staff measures

Staff identified by hospital as responsible for screening are trained in administering and interpreting cognition screen

 

Expected outcomes

  • Systems/clinical decision support tools are in place for clinical staff to undertake baseline cognitive screening for all older people presenting to hospital (within 24 hours).
  • Cognitive screening results are used to facilitate clinical assessment, clinical decision making, care planning, preventative interventions and communication.
  • Cognitive screening is aligned with the hospital’s key standardised risk assessment tools (falls, medications, mobility, nutrition).
  • Systems/clinical decision support tools are in place for clinical staff to undertake regular cognitive screening of older people if there is a sudden change in behaviour, deterioration in condition or if the older person has been identified “at risk” of developing confusion.
  • In older people, cognitive screening is repeated at regular intervals to provide ongoing assessment or if there is a sudden change in behaviour or deterioration in the older person’s condition. 

References

  1. Clinical Epidemiology and Health Service Evaluation Unit, Melbourne Health in collaboration with the Delirium Clinical Guidelines Expert Working Group. Clinical Practice Guidelines for the Management of Delirium in Older People, 2006.
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