In 2019, based on the learning from three acute hospital projects funded by the HSE/Genio to develop integrated care pathways for a person with dementia presenting to their hospital, a national working group has developed three pathways to guide the care of a person with dementia. These pathways can be modified by hospital groups or individual hospitals as needed for the local context. Please refer to the " People Living with Dementia who require admission to an acute hospital: Principles of Care” document for supporting principles and more details.
In addition, two existing delirium algorithms developed by the National Clinical Programme for Older People were updated in 2019 by the working group.
The Integrated Care Pathway for a person with known dementia who presents acutely or in potential crisis describes the integrated care pathway between the community and an acute hospital and back again.
Within this overarching pathway for a person with dementia, there are specific dementia pathways and delirium algorithms for use in the ED/AMAU and for the general wards:
Early Identification and Management of Delirium in the Emergency Department/ Acute Medical Assessment Unit Algorithm
Dementia / Delirium Combined Pathway and Care Bundle for Emergency Department and Acute Medical Assessment Unit
These are designed to be used together- please print out as a two-sided A4 page for resource/pathway folders, or as two A3 posters for side-by-side display in the ED/AMAU. The delirium algorithm is updated from Version 1.0 in 2015, and has been nationally endorsed by all relevant national clinical programmes, and is based closely on a draft European guidance document. It should not be modified.
The result of the 4AT test in the delirium algorithm (page 1) indicates the pathway to be followed on page 2. Note that page 2 has a single dementia and/or delirium care bundle for simplicity, as a person with known or suspected dementia and/or delirium is cognitively vulnerable and the principles of care are the same regardless of the final diagnosis. This page can be locally modified as required.
- “Integrated Dementia Care Pathway for Acute Hospital Wards” and “Diagnostic Pathway for Suspected Dementia on Acute Hospital Wards will be available to download in mid-2020.
These are designed to be used together- please print out as a two-sided A4 page for ward resource/pathway folders, or as two A3 posters for side-by-side display on the ward.
All in-patients with known dementia will follow the delirium algorithm, as delirium prevention/management is crucial, but in addition, there are other important care considerations for this patient- these are presented as a care bundle.
Similarly, a patient with suspected dementia is treated according to the delirium algorithm, but also needs to follow the diagnostic pathway for suspected dementia (and often also the “known dementia” pathway if dementia seems highly likely).
These care pathways can be locally modified as needed to fit local resources/other pathways of care.