1. JANUARY 14, 2016

2. CIRAC PROJECT-WHAT IT IS
CIRAC=COGNITIVE IMPAIRMENT RECOGNITION IN ACUTE CARE
A CHH PARTNERSHIP WITH THE ALZHEIMER’S ASSOCIATION
A WAY TO RECOGNIZE UNUSUAL BEHAVIORS AS AN INDICATOR OF POSSIBLE COGNITIVE IMPAIRMENT
“SEE SOMETHING, SAY SOMETHING”

3. CIRAC PROJECT-WHY IS IT IMPORTANT
FAILURE TO RECOGNIZE COGNITIVE IMPAIRMENT IN HOSPITALIZED PATIENTS LEADS TO POOR OUTCOMES
MANY SIGNS OF COGNITIVE CHANGES ARE SUBTLE AND MAY BE IGNORED OR NOT RECOGNIZED
UP TO 45% OF HOSPITALIZED ELDERS MAY HAVE COGNITIVE IMPAIRMENT
LEADS TO POOR TRANSITIONS OF CARE AND DISCHARGE PLANNING

4. CIRAC PROJECT-GOALS
IDENTIFY COGNITIVE IMPAIRMENT EARLY, BY WAY OF “UNIVERSAL OBSERVATIONS”, AND ENSURE THE DOCTOR KNOW ABOUT THE FINDINGS
INCREASE SAFETY AND SATISFACTION
DECREASE LENGTH OF STAY
DECREASE READMISSIONS
IMPROVE TRANSITIONS OF CARE
IMPROVE FOLLOW UP AND CONTINUITY

5. CIRAC “Light is good from whatever lamp it shines.”
~Author Unknown
Therefore , first cornerstone principle for CIRAC is “Universal Observations”

6. CIRAC-UNIVERSAL OBSERVATIONS
Universal Observations is an approach to recognition of cognitive impairment.
According to the concept of Universal Observations, all patients should be looked upon, by all staff, as being at risk for, and possibly having, cognitive impairment.

7. CIRAC-UNIVERSAL PRECAUTIONS
ALL Hospital/Acute Care staff members observe patients.
Registration, nursing, laboratory and radiology, housekeeping, security, volunteers, dietary…
Behaviors and appearances possibly indicative of Cognitive Impairment are reported to clinical staff who can follow up.
If you See Something, Say Something.

8. RED FLAGS-BEHAVIORS
What should trigger a report to a clinical staff member?
Some abnormal behaviors are fairly obvious:
Patient has fallen
Pt. is screaming or crying
Pt. throws something at a staff member
Pt. cannot be awakened
Pt. acts paranoid, is having hallucinations, talks “out of their head”
**If unsafe-call for help

9. RED FLAGS-BEHAVIORS
Some behaviors are equally important but not as obvious:
Pt. described as “Poor Historian”
Pt. is given food tray but makes no attempt to eat, especially if more than one meal
Repeatedly fails to follow instructions or answer questions
Appears “bewildered”
Unexpectedly wets or soils bed
Becomes extremely agitated over a small matter
Others

10. SEE SOMETHING/SAY SOMETHING
See something/Say something means:
You (whomever you are) see something (a red flag behavior), and you say something (verbal or written) to a clinical person who knows the patient (a nurse, midlevel provider, doctor)
No one has to do a screening test
No one has to make a diagnosis except the doctor

11. SEE SOMETHING/SAY SOMETHING
See something / say something does NOT:
Label the patient
Cause a diagnosis to be entered in the chart
But it should:
Lead to further inquiry
And if pt. confirmed as cognitively impaired, can
allow them to be identified.
Identification leads to allowing pt’s status to be
known to others and evaluation as needed
Primary goal: Recognition

12. SEE SOMETHING/SAY SOMETHING
Reporting to nursing staff
Verbal is acceptable, especially nurse-to-nurse
Other staff to nurse – written observation
Purple Notebooks provided

13. PROCESS-ANY STAFF
Staff recognizes indicator of cognitive impairment/Unusual behaviors or “red flags”
***Staff reports/documents behavior in purple binder log at nurse’s station.
***If the Patient is wearing an ORANGE Armband, then you will not need to log the behavior in the purple binder.

14. PROCESS-NURSING
Charge nurse reviews entries on the log in the purple binder
Charge nurse determines behavior may be due to unrecognized cognitive impairment.
Charge nurse reports to admitting Provider

15. SEE SOMETHING/SAY SOMETHING
Communication of patient’s Cognitive Impairment to others in the Acute Care setting:
-Confirm it:
See something/say something leads to clinician recognition of Cognitive Impairment
-Chart it:
Nurse/clinical provider documents Cognitive Impairment and/or a diagnosis in patient’s chart
-Convey the information:
Identify patient to others in the Acute Care setting

16. Patient identifier implemented
PROCESS FOR KNOWN COGNITIVE IMPAIRMENT
Patient or family member discloses presence of cognitive impairment, Alzheimer’s or another dementia to staff member
Staff documents in Admission History and Reviews Physician H&P for confirmation of diagnosis
Patient identifier implemented
ORANGE ARMBAND

17. SUMMARY Notification of house wide implementation date.
***Will notify everyone of GO-LIVE date
CIRAC Project Empowers all Hospital staff/volunteers who come in contact with patients to report unusual behaviors.
Standardized process (documentation in purple binders) to improve recognition, awareness, safety, and reporting.
Improves patient care, continuity, follow up and
transitions.

18. PLEASE COMPLETE POST-TEST
THANK YOU
PLEASE COMPLETE POST-TEST