CogChamps: Using Cognition Champions to embed a new model of care for hospitalised older patients with cognitive impairment

The intervention was implemented across 6 wards (2 surgical, 4 medical) at the Princess Alexandra Hospital (PAH; The Intervention Hospital) , Brisbane. Experienced nurses (with more than two years clinical experience), and (a) a specific interest in dementia and delirium, or (b) leadership skills, were identified to become Cognition Champions (CogChamps). CogChamps are nurses who will champion best practice care for older patients with cognitive impairment (CI) including dementia and delirium in hospital. They were provided with comprehensive dementia and delirium education and training (Workshop 1) and education about leadership and change management skills (Workshop 2) to facilitate changing care practices, through two full days of Workshops. Workshop 1 topics included: Project Overview (presented by Catherine Travers, PhD., Chief Investigator) Dementia versus delirium (presented by PAH's Clinical Nurse Consultant (CNC) - Dementia and Delirium & a PAH Geriatrician), Important issues associated with CI in hospital (presented by PAH's CNC - Dementia and Delirium), Behavioural and psychological symptoms of dementia (presented by PAH's CNC - Dementia and delirium), The assessment of delirium using the Confusion Assessment Method (CAM), This 2 hour session included a demonstration of the CAM by the hospital's CNC - Dementia and delirium, practice using the CAM by the CogChamps in pairs, as well as supervised real-life practice by each CogChamp on their home ward. Supervision was provided by either a hospital Geriatrician or a nurse well versed in use of the CAM, who observed each CogChamp administer the CAM and interpret the results (with discussion and feedback); Delirium prevention and management (presented by one of the Investigators - Dr Judy McCrow who developed a validated online learning package for nurses about delirium); Pharmaceuticals (presented by PAH's Pharmacist); Implementing change in the workplace: Participants were introduced to the modified Knowledge Translation (KT) framework. The model outlines four steps for effective knowledge translation: awareness, agreement, adoption, and adherence. Participants were asked to complete a homework activity that involved considering which KT stage both they and their ward were at, and outline the steps required to transition from that stage to the next stage in the continuum (presented by one of the project's Investigators - a Nursing Professor with extensive geriatric nursing experience) . The activity was completed prior to, and in preparation for, Workshop 2. Workshop 2 topics included: What is a Cognition Champion? (presented by the Chief Investigator) Elements of change and how to influence it (presented by PAH's Nurse Educator), Development of a ward specific Action Plan by the CogChamps (2 hour session - small group activity), This activity was facilitated by three of the project's Investigators, Communication skills including assertive communication, setting clear expectations, and tools and strategies for providing feedback (presented by PAH's Nurse Educator).. Both workshops were delivered face-to-face and were presented twice to ensure the CogChamps were able to attend with a maximum of 20 participants per Workshop. All participants received continuing practice development points and a certificate for participation. A key component of Workshop 2 was the development of ward specific Action Plans by the CogChamps who were asked to identify areas in their home wards where the care of patients with CI could be improved, and develop specific plans to make those improvements. This ensured that the specific interventions to be adopted addressed the local needs of each ward and the preferences of the CogChamps working on those wards. Examples of the Action items included the development of checklists for nurses to use when managing a patient who appears to have delirium; and the provision of education about delirium and its assessment for ward nurses. The CogChamps were supported by the Research team and project facilitators (at least weekly face-to-face contact ranging from 10 minutes to 1 hour) to implement their Action Plans over a 5 month period (June - October 2016).. The aims of the meetings were to: Mentor CogChamps to implement their Action Plans, Ascertain and document progress towards the implementation of each ward’s Action plan, Identify any barriers to progress, and guide CogChamps to identify possible solutions, Provide feedback to CogChamps regarding their progress, and Assist CogChamps to develop processes essential to effective project implementation (e.g. systems for communicating between CogChamps on each ward who work differing rosters). The impact and effectiveness of the CogChamps project was assessed by collecting the same outcome data from 2 wards (a medical and a surgical ward) at a comparable site, located nearby (approximately 10 kilometers away) - he Control hospital