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A patient journey for use in acute careThe patient presents to the Emergency Department, Preadmission Clinic or ward.
Cognitive screen and delirium screen completed (refer to page 3 and 7) by Emergency Department (ED) staff for all patients over 65 or 45 for ATSI communities completed as discussed on age 3 and 7 by ED staff for all patients over 65 or 45 for ATSI communities.
Does the delirium screen indicate delirium? If no, ED staff document cognitive and delirium screen in patient medical notes. Commence prevention strategies (refer to page 5) to avoid a delirium. Discharge Planning to include consultation with external service providers including Family/Carer and GPs.
If delirium screen indicates delirium, ED doctor to provide a diagnosis of cause of delirium (refer to page8 to 10).
ED hand over by phone or person to ward and inform family/carer.
Patient arrives on the ward. Patient identified with delirium or “at risk”.
The admitting nurse checks status of interventions and completes outstanding; gain additional information from family/carer/facility; manage modifiable risk factors (refer to page 4); refer to advanced care plan; and manage symptoms (refer to page 11).
Medical team to review cause (refer to page 8 to 10); Medication review; and Pharmacological Management only if required (refer to page 12).
Monitor the cognitive function for change (refer to page 3); record in medical notes; and manage symptoms (refer to page 11).
Provide education to patient, family/ carer, aged care facility and relevant staff as outlined on page 14. Consider using an interpreter and provide supportive care.
If there is a reduction in severity of symptoms or reoccurrence rate, discharge Planning to include consultation with external service providers including Family/Carer and GPs.
If there is no reduction in severity of symptoms or reoccurrence rate, return to the step in which the patient arrives on the ward and is identified with delirium or “at risk”.
* To use assessments or screens as used in own facilities/services or other relevant material.
Ref GWAHS Broken Hill Aged Care Project 2008