Care of Confused Hospitalised Persons (CHOPs) program

Aim

Provide simple strategies to improve the care outcomes of older patients with confusion in NSW hospitals, through:

  • increased staff knowledge and skills to identify, treat and care for older people presenting to their hospitals with confusion
  • involvement of carers and families.

Achievements, innovation and knowledge will be shared and systems embedded into practice to sustain and spread improvements in care.

Benefits

  • Increased screening, improved risk assessment and more appropriate treatment and management of confusion.
  • Increased awareness, knowledge and skills of staff to better care for older patients with dementia/delirium.
  • Minimisation of harm during care and safer and more supportive hospital environments.
  • Improved patient outcomes, including:
    • prevention of functional decline
    • reduced morbidity and adverse events
    • reduced length of stay
    • reduced readmissions
    • reduced rate of admission to a residential aged care facility upon discharge.
  • Greater accuracy of coding for delirium DRGs.
  • Reduced per capita cost.

Summary

CHOPs aims to improve the care of older people with cognitive impairment in hospital, through implementation of Key Principles for Care of Confused Hospitalised Older Persons, which focus on the following key elements:

  • Cognitive screening: Screening and identification of people with cognitive impairment.
  • Risk identification and prevention strategies: Identification of people at risk of developing delirium while in hospital and putting preventive strategies in place.
  • Assessment and appropriate management: Further investigation/assessment to determine causes that guides treatment and appropriate management.
  • Communication: Importance of engaging with families/carers, adopting and communicating a person centred approach.
  • Staff education: Staff have the right knowledge, skills and attitudes.
  • Supportive care environment: A ward environment that is safe and supports quality care.

Through use of Accelerated Implementation Methodology (AIM), the program focuses on tailored intervention and the ability to respond to issues identified by staff in clinical settings.

Background

It is estimated that nearly one third of patients admitted to hospital has some form of cognitive impairment. The prevalence of cognitive impairment (dementia and delirium) is directly related to our aging population.

Dementia and/or delirium are the most common causes of confusion in older people. Older patients with confusion have particular vulnerabilities and risks. They are much more susceptible to falls, pressure injury, malnutrition and functional decline, have poorer health outcomes and longer lengths of stay in hospital. They are also much more likely to be prematurely admitted to residential care or die from hospital related complications.

People with confusion can experience fear, stress and anxiety when admitted to the busy, noisy hospital environment. They frequently have difficulties in language and communication. This in turn can pose particular challenges for family, carers and clinical staff providing care.

The CHOPs program was initially established as a pilot program in five NSW hospitals in 2011. The lessons learnt from pilot sites led to the development of seven Key Principles for Care of the Confused Hospitalised Older Person. These principles have been used to guide the implementation of CHOPs in 13 public hospitals.

Partnerships

The key funding partner for the CHOPs program implementation and evaluation is the National Health & Medical Research Council (NHMRC) – Cognitive Decline Partnership Centre (CDPC).

In collaboration with:

Key Dates

July 2013

July 2013 - September 2013

Project initiation 

Diagnostics

Case for change.

Key principles development.

Solution design

Develop data collection methods.

Evaluation framework developed.

LHD consultations.

Site selection process determined.

July 2013

July 2013 - June 2014

Strategies developed to incorporate into state wide systems including ongoing data collection.

Communications Plan developed.

October 2013

October - December 2013

Implementation

Phase 1 sites implementation planning.

Project teams established; ACI site visits.

AIM training.

Pre-implementation audits.

Gap analysis and development of implementation plan.

October 2013

October 2013 - March 2015

Phase 1 sites implementation.

April 2014

April 2014 - March 2015

Phase 1 sites post-implementation data collection and analysis.

July 2014

July 2014 - December 2015

Phase 2 sites implementation & evaluation.

February 2015

February 2015 - June 2016

Phase 3 sites implementation & evaluation.

June 2015

June 2015 - December 2015

CHOPs website redevelopment.

January 2016

January 2016 - June 2016

Evaluation

Overall CHOPs program evaluation

Pilot Sites

Hunter New England Local Health DistrictArmidale Rural Referral Hospital
Northern Sydney Local Health DistrictRyde Hospital
South Western Sydney Local Health DistrictCampbelltown Hospital
Southern NSW Local Health DistrictBateman's Bay District Hospital
Pambula District Hospital

Implementation Sites

Implementation will be determined after the evaluation of the 2015 pilot period.

Central Coast Local Health DistrictGosford Hospital

Phase 1


Far West Local Health DistrictBroken Hill Base Hospital

Phase 2


Hunter New England Local Health DistrictThe Maitland Hospital

Phase 3


Illawarra Shoalhaven Local Health DistrictWollongong Hospital

Phase 2


Mid North Coast Local Health DistrictCoffs Harbour Base Hospital

Phase 3


Nepean Blue Mountains Local Health DistrictNepean Hospital

Phase 3


Springwood Hospital

Phase 3


Northern NSW Local Health DistrictLismore Base Hospital

Phase 1


Northern Sydney Local Health DistrictHornsby Ku-ring-gai Hospital

Phase 2


South Eastern Sydney Local Health DistrictPrince of Wales Hospital

Phase 1


South Western Sydney Local Health DistrictFairfield Hospital

Phase 3


Sydney Local Health DistrictCanterbury Hospital

Phase 3


Western NSW Local Health DistrictOrange Health Service

Phase 2


Evaluation

The implementation of CHOPs uses a Clinical Redesign project implementation framework. Pre and post implementation measures include

  • Medical record audit
  • Staff knowledge and care confidence survey
  • Staff and carer focus groups
  • Patient Experience Trackers
  • Environmental audit.

The Redesign project methodology is embedded in CHOPs implementation tools which are available on the CHOPs website.

Contact

Glen Pang
Aged Health Network Manager
glen.pang@health.nsw.gov.au
02 9464 4630

Chris Shipway
Director, Primary Care and Chronic Services
chris.shipway@health.nsw.gov.au
02 9464 4603

Page Top | Added: 13 August 2015 | Last modified: 14 August 2015