All about interRAI…...Delirium, Falls, Pressure Ulcer Clinical Assess’t Protocols Setting...
Transcript of All about interRAI…...Delirium, Falls, Pressure Ulcer Clinical Assess’t Protocols Setting...
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All about interRAI…
Len Gray
Coordinator, interRAI Network of Excellence in Acute Care
April 2014
www.interrai.org
The interRAI research collaborative
30+ nations
80+ clinicians &
scientists
Australia
Belgium
Canada
Chile
China
Czech Republic
Denmark
Estonia
Finland
France
Germany
Hong Kong
Iceland
India
Israel
Italy
Japan
Lithuania
New Zealand
Netherlands
Norway
Poland
South Korea
Spain
Sweden
Switzerland
Taiwan
United Kingdom
United States of America
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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…
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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
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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…
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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
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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
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Clinical
observations
Outcome
measurement
scales
Quality
indicators
Case mix
Indications for
clinical
intervention
Diagnostic &
risk screening
Clinical
summaries
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The interRAI Acute Care
Diagnostic
screeners
Delirium
Dementia
Depression
Malnutrition
Risk assessment
Delirium
Pressure ulcer
Falls
Functional decline
Institutional care
Readmission
Severity measures
Delirium
Cognition
Communication
Mood
ADL
IADL
Pain
Nutrition Recommendations
(CAPs)
ADL
Cognition
Communication
Delirium
Depression
Pain
Pressure ulcer
Institutional risk
Readmission
Medications
Quality indicators
Self care, mobility,
IDC, falls, pressure
ulcer, institutional
placement
Clin
ica
l
observ
ations
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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
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The interRAI
Hospital Mini-Suite
interRAI ED interRAI AC interRAI PAC interRAI HC Assessment tools
Emergency Department
Acute Ward Post Acute Ward Post Acute Community
Standalone Screener
Need for CGA
Derivative measures
Severity measures Multi-setting
General: Function, Frailty Specific : Cognition, Communication, ADL, IADL, Pain, Nutrition
Quality indicators Setting specific
Outcome QIs
Delirium, Dementia, Malnutrition, Depression Diagnostic screeners Setting specific
Risk screeners Setting specific
Delirium, Falls, Pressure Ulcer
Clinical Assess’t Protocols Setting specific
Acute Care CAPs Home Care CAPs Post-acute Care
CAPs
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interRAI AC 2009
interRAI HC 2005
interRAI ED Screener 2014
Ward Admission Assessment
SPECIALIST GERIATRIC ASSESSMENT
GENERAL ASSESSMENT
interRAI AC-PAC 2015
interRAI ED CA 2014
General ward geriatric care
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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
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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
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interRAI in action
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Websites...
CRGM www.som.uq.edu.au/research/crgm
interRAI Australia
www.interrai-au.org
RAIplus
www.raiplus.com
CeGA Online
www.cegaonline.com