Concerns expressed by Pam Tripaldi, the daughter of a dementia patient, resulted in the Pennsylvania Patient Safety Advisory issuing a report analyzing the potential risks of poor dementia identification in acute care settings, according to an article published in The Philadelphia Inquirer.
Here are six things to know about unrecognized dementia in hospital settings and Ms. Tripaldi's experience.
1. In the Inquirer, Ms. Tripaldi relays a concerning tale regarding her father's healthcare experience. John Schatz, her father, retained his social and verbal skills well after his memory began to wane. Standing outside her father's room in the emergency department, she heard a radiology technician prepping for an X-ray ask, "Are you a diabetic?" Mr. Schatz answered no, though he was indeed a diabetic. Because X-rays can harm insulin pumps, this could have placed her father at risk, but Ms. Tripaldi entered the room and promptly corrected her father. Ms. Tripaldi stated she only witnessed small lapses in communication between her father and the hospital staff, but in these lapses she saw potential for greater errors.
2. Michelle Feil, MSN, RN, who authored the report for the PPSA, analyzed hospital data from January 2005 to December 2014 and found 63 "near misses" for adverse events related to staff unawareness of a patient's dementia. Ms. Feil said researchers estimate physicians fail to recognize dementia 19 to 67 percent of the time in outpatient settings, according to the Inquirer.
3. In one case discovered by Ms. Feil, an elderly man told physicians that he had no hardware in his leg prior to a procedure to amputate that limb. His surgeon discovered a metal rod in the leg that had to be cut through. While the surgery was performed successfully, the case highlights the potential pitfalls caused by unrecognized dementia.
4. Ms. Feil separated the mistakes she discovered in the analysis into five categories: failure to recognize the dementia, failure to assess a patient's decision-making ability, failure to identify someone capable of relaying reliable history or making decisions, failure by the hospital to contact the surrogate and failure to communicate the patient's cognitive limitations to all members of the care team.
5. Ms. Tripaldi and others have called for the implementation of colored wristbands to signal a patient's cognitive state to providers. But Ms. Feil isn't convinced that would be a solution. One of the earlier studies from the Safety Authority examined the confusion experienced by nurses when they transitioned from one hospital to another where wristband color coding can vary. Though institutions now make efforts to standardize color meaning, Ms. Feil, according to the Inquirer, thinks the fewer the wristbands the better. "We at the authority aren't suggesting that people add another wristband," she said.
6. Ms. Feil and the Safety Authority assert that every new patient 65 and older should be examined for dementia and that a hospitalwide communication system should be implemented to inform all individuals on the care team of the results. The patient's decision making capabilities should also be determined in order to avoid potential errors.
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