Care of Confused Hospitalised Persons (CHOPs) program
Provide simple strategies to improve the care outcomes of older patients with confusion in NSW hospitals, through:
- increased staff knowledge and skills to identify, treat and care for older people presenting to their hospitals with confusion
- involvement of carers and families.
Achievements, innovation and knowledge will be shared and systems embedded into practice to sustain and spread improvements in care.
- Increased screening, improved risk assessment and more appropriate treatment and management of confusion.
- Increased awareness, knowledge and skills of staff to better care for older patients with dementia/delirium.
- Minimisation of harm during care and safer and more supportive hospital environments.
- Improved patient outcomes, including:
- prevention of functional decline
- reduced morbidity and adverse events
- reduced length of stay
- reduced readmissions
- reduced rate of admission to a residential aged care facility upon discharge.
- Greater accuracy of coding for delirium DRGs.
- Reduced per capita cost.
CHOPs aims to improve the care of older people with cognitive impairment in hospital, through implementation of Key Principles for Care of Confused Hospitalised Older Persons, which focus on the following key elements:
- Cognitive screening: Screening and identification of people with cognitive impairment.
- Risk identification and prevention strategies: Identification of people at risk of developing delirium while in hospital and putting preventive strategies in place.
- Assessment and appropriate management: Further investigation/assessment to determine causes that guides treatment and appropriate management.
- Communication: Importance of engaging with families/carers, adopting and communicating a person centred approach.
- Staff education: Staff have the right knowledge, skills and attitudes.
- Supportive care environment: A ward environment that is safe and supports quality care.
Through use of Accelerated Implementation Methodology (AIM), the program focuses on tailored intervention and the ability to respond to issues identified by staff in clinical settings.
It is estimated that nearly one third of patients admitted to hospital has some form of cognitive impairment. The prevalence of cognitive impairment (dementia and delirium) is directly related to our aging population.
Dementia and/or delirium are the most common causes of confusion in older people. Older patients with confusion have particular vulnerabilities and risks. They are much more susceptible to falls, pressure injury, malnutrition and functional decline, have poorer health outcomes and longer lengths of stay in hospital. They are also much more likely to be prematurely admitted to residential care or die from hospital related complications.
People with confusion can experience fear, stress and anxiety when admitted to the busy, noisy hospital environment. They frequently have difficulties in language and communication. This in turn can pose particular challenges for family, carers and clinical staff providing care.
The CHOPs program was initially established as a pilot program in five NSW hospitals in 2011. The lessons learnt from pilot sites led to the development of seven Key Principles for Care of the Confused Hospitalised Older Person. These principles have been used to guide the implementation of CHOPs in 13 public hospitals.
The key funding partner for the CHOPs program implementation and evaluation is the National Health & Medical Research Council (NHMRC) – Cognitive Decline Partnership Centre (CDPC).
In collaboration with:
- Ministry of Health Older People’s Mental Health Unit, Aged Care Integration Unit
- The Australian Commission on Safety and Quality in Health Care
- Cognitive Decline Partnership Centre.
July 2013 - September 2013
Case for change.
Key principles development.
Develop data collection methods.
Evaluation framework developed.
Site selection process determined.
July 2013 - June 2014
Strategies developed to incorporate into state wide systems including ongoing data collection.
Communications Plan developed.
October - December 2013
Phase 1 sites implementation planning.
Project teams established; ACI site visits.
Gap analysis and development of implementation plan.
October 2013 - March 2015
Phase 1 sites implementation.
April 2014 - March 2015
Phase 1 sites post-implementation data collection and analysis.
July 2014 - December 2015
Phase 2 sites implementation & evaluation.
February 2015 - June 2016
Phase 3 sites implementation & evaluation.
June 2015 - December 2015
CHOPs website redevelopment.
January 2016 - June 2016
Overall CHOPs program evaluation
|Hunter New England Local Health District||Armidale Rural Referral Hospital|
|Northern Sydney Local Health District||Ryde Hospital|
|South Western Sydney Local Health District||Campbelltown Hospital|
|Southern NSW Local Health District||Bateman's Bay District Hospital|
Pambula District Hospital
Implementation will be determined after the evaluation of the 2015 pilot period.
|Central Coast Local Health District||Gosford Hospital|
|Far West Local Health District||Broken Hill Base Hospital|
|Hunter New England Local Health District||The Maitland Hospital|
|Illawarra Shoalhaven Local Health District||Wollongong Hospital|
|Mid North Coast Local Health District||Coffs Harbour Base Hospital|
|Nepean Blue Mountains Local Health District||Nepean Hospital|
|Northern NSW Local Health District||Lismore Base Hospital|
|Northern Sydney Local Health District||Hornsby Ku-ring-gai Hospital|
|South Eastern Sydney Local Health District||Prince of Wales Hospital|
|South Western Sydney Local Health District||Fairfield Hospital|
|Sydney Local Health District||Canterbury Hospital|
|Western NSW Local Health District||Orange Health Service|
Key Date (location) Pilot Site Implementation Site
The implementation of CHOPs uses a Clinical Redesign project implementation framework. Pre and post implementation measures include
- Medical record audit
- Staff knowledge and care confidence survey
- Staff and carer focus groups
- Patient Experience Trackers
- Environmental audit.
The Redesign project methodology is embedded in CHOPs implementation tools which are available on the CHOPs website.
CHOPs is linked to a number of other safety initiatives and models of care. These include:
- The Australian Commission on Safety & Quality in Health Care - A better way to care: Safe and high-quality care for patients with cognitive impairment (dementia & delirium) in hospital
- The CEC Falls and Top 5 programs
- The ACI Consumer Engagement program
- The Hip Fracture Guidelines
- Orthogeriatric Models of Care
- NSW 2021: A Plan to Make NSW Number One:
- Providing world class clinical services with timely access and effective infrastructure
- The NSW Dementia Services Framework 2010-2015
- Clinical Practice Guidelines for the Management of Delirium 2006 and Delirium Care Pathways 2010
- Commonwealth’s aged care reform package: Living Longer, Living Better.
Aged Health Network Manager
02 9464 4630
Director, Primary Care and Chronic Services
02 9464 4603
Page Top | Added: 13 August 2015 | Last modified: 14 August 2015