Improving staff awareness of sensory aid needs and dementia status in an old age ward

Abstract

Background: Having initially done our critical appraisal of various studies, we found that geriatric wards have a higher prevalence of delirium and dementia. Among this older population, sensory aids were found to be important in orientating delirious patients, and deficits in vision/hearing were associated with an increased risk of delirium. Delirium and dementia are associated with increased morbidity and mortality. This quality improvement project aimed to increase staff awareness of patient sensory aid needs and thus improve patient care as a result.

Methods: We started off with a driver diagram to identify what the primary and secondary drivers are for improving the quality of care for patients with sensory impairment. Of the drivers discussed, we believed that we could have a meaningful impact on improving sensory impairment awareness among the multidisciplinary team (MDT) on the ward. We then went through our Plan, Do, Study, Act (PDSA) cycles, which were as follows: PDSA cycle 1, where I and my two colleagues educated the MDT on how to use the electronic patient records property form checklist, which was being underused. This form tracks whether patients require sensory aids. We did three teaching sessions during board rounds and audited the use of this form over time. PDSA cycle 2 used a laminated bedside checklist that is filled in by the MDT and is used as a visual reminder of the patient's sensory impairment status.

Results: The EPR form completion rate increased by 14% over a period of 4 weeks, although this was not statistically significant. 18% of the bedside checklists were filled in, which was statistically significant. Both interventions in combination led to a statistically significant increase in sensory impairment awareness, with a 32% decrease in sensory aid unknown rates, a 40% decrease in dementia unknown rates and a 56% decrease in both sensory and dementia unknown rates. Delirium status was not formally assessed in this QIP due to documentation inconsistencies; however, its relevance remains acknowledged.

Keywords: Healthcare quality improvement; Hospital medicine; Quality improvement.