All about interrai. Len Gray Coordinator, interrai Network of Excellence in Acute Care April

Transcription

1 All about interrai Len Gray Coordinator, interrai Network of Excellence in Acute Care April 2014

2 The interrai research collaborative Australia Belgium Canada Chile China Czech Republic Denmark Estonia Finland France Germany Hong Kong Iceland India Israel 30+ nations 80+ clinicians & scientists Italy Japan Lithuania New Zealand Netherlands Norway Poland South Korea Spain Sweden Switzerland Taiwan United Kingdom United States of America

3 Improving care of people with cognitive impairment in hospital Case identification is critical We need to identify patients with delirium and dementia Let s select best of breed screening tools Who to complete? What about nurses? Yes good idea it only will need 5-10 minutes Introduce a CAM and AMT into the nursing intake protocol 4

4 Wait a minute There are other critical geriatric syndromes and functional issues that we should identify Undernutrition Depression ADL impairment And of course there are risks to be identified Falls Pressure ulcer Let s search the literature for best of breed diagnostic and risk screening tools 5

5 This will need a meeting or two Let s create a TWO PIZZA ASSESSMENT SYSTEM Organise the key stakeholders with Pizzas Select best of breed screeners Fill in the gaps with some items we make ourselves Reduce the font size to keep it to less than 4 pages to minimise the workload for nurses Present the product to key stakeholders over PIZZA MISSION ACCOMPLISHED 6

6 A Compilation Assessment System The Data Items CAM AMT Hamilton DRS MNA Waterlow Katz ADL FRAT Various fillers to meet nursing requirements The Result Inconsistent scoring methods Item duplication Training challenges IT unfriendly Significant documentation burden Poor compliance 7

7 interrai Design Principles Build assessment systems from the ground up Fit for purpose for each clinical context Standardised item design Collect data once and use for multiple purposes Share core items and scalar measures across settings Design for the digital era Robust item and application testing across multiple nations 8

8 Clinical observations Diagnostic & risk screening Indications for clinical intervention Clinical summaries Outcome measurement scales Quality indicators Case mix

9 Clinical observations The interrai Acute Care Diagnostic screeners Risk assessment Severity measures Recommendations (CAPs) Quality indicators Delirium Dementia Depression Malnutrition Delirium Cognition Communication Mood ADL IADL Pain Nutrition Self care, mobility, IDC, falls, pressure ulcer, institutional placement Delirium Pressure ulcer Falls Functional decline Institutional care Readmission ADL Cognition Communication Delirium Depression Pain Pressure ulcer Institutional risk Readmission Medications

10 The Hospital Journey ED Acute Care Post - Acute Care Post - Acute Community Care CAM AMT CAM MMSE Waterlow FRAT MNA FIM MMSE GDS Barthel MMSE Result: Inconsistent data format; high documentation burden; poor compliance; no data sharing

11 The interrai Hospital Mini-Suite Emergency Department Acute Ward Post Acute Ward Post Acute Community Standalone Screener Need for CGA Assessment tools interrai ED interrai AC interrai PAC interrai HC Derivative measures Clinical Assess t Protocols Setting specific Severity measures Multi-setting Diagnostic screeners Setting specific Risk screeners Setting specific Quality indicators Setting specific Acute Care CAPs Post-acute Care CAPs General: Function, Frailty Specific : Cognition, Communication, ADL, IADL, Pain, Nutrition Delirium, Dementia, Malnutrition, Depression Delirium, Falls, Pressure Ulcer Outcome QIs Home Care CAPs

12 GENERAL ASSESSMENT SPECIALIST GERIATRIC ASSESSMENT interrai ED Screener 2014 interrai ED CA 2014 Ward Admission Assessment interrai AC 2009 General ward geriatric care interrai AC-PAC 2015 interrai HC

13 The interrai Suite for vulnerable populations Long term care Assisted living Home care Community health Emergency department Acute care Post acute care Palliative care Mental health Community mental health Child and youth mental health MH for correctional facilities Child and youth intellectual disability Intellectual disability Deaf blind Quality of life Wellness 14

14 CI in hospital: What can interrai offer? Robust screening for cognitive impairment and delirium as part of an integrated system of care Comprehensive assessment of all functional & psychosocial needs for complex cases Clinical protocols for intervention sensitive subpopulations Casemix adjustment accounting for cognitive and physical function Quality indicators Continuity across the hospital community pathway 17

15 interrai in action

16 Websites... CRGM interrai Australia RAIplus CeGA Online