Screening for Delirium, Dementia and Depression in Older Adults
Screening for Delirium, Dementia and Depression in Older Adults
Screening for Delirium, Dementia and Depression in Older Adults
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<strong>Screen<strong>in</strong>g</strong> <strong>for</strong> <strong>Delirium</strong>, <strong>Dementia</strong> <strong>and</strong> <strong>Depression</strong> <strong>in</strong> <strong>Older</strong> <strong>Adults</strong>IndicatorStructureProcessOutcomeObjectives• To evaluate the supportsavailable <strong>in</strong> the organizationthat allow <strong>for</strong> nurses to<strong>in</strong>tegrate <strong>in</strong> their practice theassessment <strong>and</strong> screen<strong>in</strong>g <strong>for</strong>delirium, dementia <strong>and</strong>depression <strong>in</strong> the older adults.• To evaluate the changes <strong>in</strong>practice that lead towardsappropriate use of screen<strong>in</strong>gtools to assess older adults<strong>for</strong> delirium, dementia <strong>and</strong>depression.• To evaluate the impactof implement<strong>in</strong>g therecommendations.38Organization/UnitProvider• Review of best practicerecommendations byorganizational committee(s)responsible <strong>for</strong> policies orprocedures.• Availability of clienteducation resources that areconsistent with best practicerecommendations.• Provision of accessibleresource people <strong>for</strong> nursesto consult <strong>for</strong> ongo<strong>in</strong>gsupport after the <strong>in</strong>itialimplementation period.• Percentage of nurses <strong>and</strong>other healthcare professionalsattend<strong>in</strong>g the best practiceguidel<strong>in</strong>e education sessionson geriatric mental health.• Nurse to client ratio.• Role changes e.g., roledescription, per<strong>for</strong>manceappraisal.• Development of <strong>for</strong>ms ordocumentation systems thatencourage documentation ofcl<strong>in</strong>ical assessment of delirium,dementia <strong>and</strong> depression,<strong>and</strong> concrete procedures <strong>for</strong>mak<strong>in</strong>g referrals when nursesare do<strong>in</strong>g the assessments.• Nurses’ self-assessedknowledge of:a) normal ag<strong>in</strong>gb) differential features ofdelirium, dementia, <strong>and</strong>depressionc) how to do a mentalstatus exam.d) their role <strong>in</strong> assess<strong>in</strong>g<strong>for</strong> delirium, dementia<strong>and</strong> depression as itrelates to other healthcareprofessionals.• Percent of nurses self-report<strong>in</strong>gadequate knowledge ofcommunity referral sources<strong>for</strong> clients with geriatricmental health problems(physicians, nurse practitioner,geriatric psychiatricconsultants, AlzheimerSociety of Canada).• Orientation program<strong>in</strong>clusion of delirium,dementia <strong>and</strong> depression• Accreditation review <strong>in</strong>this aspect.• Organization reputationdirectly reflect<strong>in</strong>g care <strong>in</strong>this regard.• Referrals <strong>in</strong>ternally <strong>and</strong>externally.• Evidence of documentation<strong>in</strong> the client’s recordconsistent with the guidel<strong>in</strong>erecommendations:a) Referral to communityresources <strong>for</strong> follow-upb) Provision of education<strong>and</strong> support to client <strong>and</strong>family members.• Client/family satisfaction.Geriatric Client• Percentage of geriatric clientsadmitted to unit/facility withmental health problems.• Percentage of clientsidentified with delirium,dementia <strong>and</strong>/or depressionupon <strong>in</strong>itial screen<strong>in</strong>g.• Percentage of clients/familiesknowledge of delirium,dementia <strong>and</strong> depression ator close to discharge.• Percentage of clients seen oron wait<strong>in</strong>g list to be seen <strong>for</strong>referral (proxy <strong>in</strong>terview iffamily member).• Percentage of clients identifiedwith delirium, dementia <strong>and</strong>/or depression with appropriateaction plan <strong>and</strong> monitor<strong>in</strong>g.• Percentage of clients referredto specialty programs <strong>for</strong>geriatric mental health(physicians, nurse practitioner,geriatric psychiatric consultants,Alzheimer Society of Canada).F<strong>in</strong>ancial Costs• Costs related to hir<strong>in</strong>g ofany new staff, equipment,etc <strong>in</strong> direct relation to thisguidel<strong>in</strong>e.• Cost related to implement<strong>in</strong>gthis guidel<strong>in</strong>e:• Education <strong>and</strong> access to onthe job supports.• New documentation systems.• Support systems.• Length of stay.• Re-admission rates.• Costs <strong>for</strong> treatments.• Re-<strong>in</strong>tegration back <strong>in</strong> thecommunity or long-termcare facility.An example of the evaluation tool used to collect data dur<strong>in</strong>g the pilot implementation of thisguidel<strong>in</strong>e can be found at the RNAO website, www.rnao.org/bestpractices.
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