Thank you, Sophie, and thank you very much, Professor Marshall, and everyone who works
at the Commission.
The process of improving the care for people with delirium and for their family and carers
is a work in progress.
But the Clinical Care Standards are a huge step forward in that process, improving the
care for people across the whole of Australia.
The Delirium Clinical Care Standard aims to ensure that patients at risk of delirium during
a hospital admission are identified promptly and receive preventative strategies.
It also aims to ensure that patients with delirium at the time of presentation to hospital
receive optimal treatment to reduce the duration and severity of their condition.
The focus of the Delirium Clinical Care Standard is on the care of adult patients at risk of
delirium or with delirium in hospitals.
However, many quality statements in the Delirium Clinical Care Standard also apply to patients
receiving palliative and / or end of life care.
While the Clinical Care Standards apply to the care received in hospitals, importantly
it can also be adapted for use by residential age care facilities.
We do not, however, address the care of delirium in children.
The Clinical Care Standards include seven quality statements or recommendations that
address key areas for improvement in the care of patients with or at risk of delirium.
These are the outline areas for the statements and I'll just give you an example of how those
Clinical Care Standards work.
The statements have many benefits that I wish to highlight.
First of all, we have involved carers, family members in ensuring high quality care for
people with delirium, and this is highlighted throughout the Clinical Care Standards.
Carers are essential to help communicate a person's history: if a person is unable to
provide informed consent, or if they are the person responsible, providing a reassuring
familiar presence, and help prevent delirium, and alert staff to ways to reduce the person's
distress.
I very much look forward to Joan Jackman’s presentation, sharing her experience as a
carer for a patient with us later.
There are indicators that have been piloted for each quality statement to allow local
health services to track the care they provide against the Clinical Care Standards.
So the first Standard at the start is early screening.
So you can see that early screening involves when patients first come to interact with
the hospital services, whether that be through the emergency department, or perhaps, a preoperative
clinic.
The purpose, to ensure patients with delirium and those at risk of delirium are identified
early so that appropriate management and preventative measures can be put in place.
As we know, and as Professor Marshall has mentioned, delirium is often missed in patients
who present to hospital, and it's only with a structured approach that we can help to
improve detection rates.
We know that age, known cognitive impairment, severe medical illness, and hip fracture are
key risk factors for delirium and there are many additional factors as well.
Patients with any one key risk factor should undergo cognitive screening and be asked if
they have noticed any recent change in their behaviour.
Cognitive screening using a validated test and asking questions about behaviour changes
helps identify patients who should be assessed for delirium.
Assessing for delirium—and this covers, then, improving the early diagnosis and timely
treatment of patients with delirium, offering the best chance of recovery through early
diagnosis and prompt treatment.
The Standards also talk about interventions to prevent delirium and they offer examples
of interventions and examples of screening and diagnostic tools without mandating any
particular tool or any particular intervention.
So it's up to the health hospitals and health facilities to determine what is best for their
group of patients.
Identifying and treating the underlying causes is obviously important if we're going to complete
the circle.
This is again going to depend on the particular patient group that is involved in that health
care facility.
We know that delirium is a key risk factor for many adverse events in the hospital.
Injurious falls and pressure injuries.
It's only by addressing the root cause, namely delirium, that we can fix these other huge
problems.
But we don't want facilities to just be sedating people with antipsychotics.
We want proper multi-component interventions so the Standards explain about minimising
the use of sedative medications.
The Standards also explain about how patients will be transitioned from hospital care and
the importance of communicating to subsequent health care professionals about the episode
of delirium and what that means for the patient in the future.
So the Delirium Care Standards are a vital step in improving the care of patients with
delirium throughout Australia, and we hope that we can share these standards with people
in other countries around the world too.
Thank you.
* * * * * Question: I was going to just ask you one
quick question while you are up here: Why do you think Australia needs these standards
in particular?
Why is it so important that we have these Standards?
Answer: We know that recognition of the importance of delirium is in its infancy and there is
fantastic support in the room for improved care for delirium, but there’s a lot of
people out there who don't yet realise the importance of delirium and we need to communicate
that to them, communicate that message.
Question: What do you think it will mean for both improving the detection and the treatment
of delirium, having these standards out there?
Answer: I think this will be a huge advance on current care for people with delirium,
and it will really improve outcomes for patients in hospital and for their carers.
Because if we can reduce the severity of delirium we can increase the number of people who go
home to live happy and healthy lives rather than ending up dead or in aged care facilities.
That's great.
Thank you very much.
Please thank Professor Caplan.