A multifaceted intervention package to improve the diagnosis and management of delirium

2014 ◽  
Vol 27 (2) ◽  
pp. 337-342 ◽  
Author(s):  
J. Fleet ◽  
S. Chen ◽  
F.C. Martin ◽  
T. Ernst
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multifaceted Intervention ◽  
Junior Doctors ◽  
Intervention Package ◽  
Post Intervention ◽  
Convenience Sample ◽  
Pharmacological Management ◽  
Hospital Patients ◽  
The Impact

ABSTRACTBackground:Delirium is a major cause of morbidity and mortality amongst hospital patients. Previous studies have shown that it is often poorly recognized and managed. We wanted to assess the impact of a multifaceted intervention on delirium management.Methods:A pre/post-intervention design was used. The local hospital delirium guideline was adapted into A7 sized cards and A3/A2 posters. Cards were distributed to junior doctors and teaching sessions were held. Computer screen savers were displayed and delirium promotion days held. The pre/post-intervention data were used to audit the following: delirium knowledge through questionnaires, documented use of the confusion assessment method (CAM) and identification and management of eight common precipitating factors. Re-audit was four months post baseline with interventions within this period. χ2 tests were used for statistical analysis.Results:A convenience sample of randomly selected doctors in postgraduate training posts completed 100 questionnaires and 25 clinical notes were selected via retrospective identification of delirium. Results from questionnaires demonstrated significant improvements in: recognizing CAM as the diagnostic tool for delirium (24% vs. 71%, p < 0.01); identifying haloperidol as first line in pharmacological management (55% vs. 98%, p <0.01) and its correct dose (40% vs. 67%, p <0.01). In clinical practice, there was significant improvement in documentation of CAM for inpatient delirium assessments (0% vs. 77%, p <0.01). Trainees found the delirium card “very helpful” (82%) and carried it with them at all times (70%).Conclusion:This multifaceted intervention increased CAM use in delirium recognition and improved the knowledge of pharmacological management. The delirium card was highly popular.

scholarly journals EP.FRI.1023 Clinical Portal: a clinician-led IT solution to the ‘surgical list’

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Cait Bleakley ◽  
Chloe Wright ◽  
Rola Salem ◽  
Kirk Bowling
Keyword(s):  
Patient Information ◽  
Single Point ◽  
Direct Consequence ◽  
Direct Access ◽  
Accurate Information ◽  
Junior Doctors ◽  
Post Intervention ◽  
It Systems ◽  
The Creation ◽  
The Impact

Abstract Aim Burnout amongst junior doctors is an emotive topic, with time pressures during busy on-call shifts negatively impacting efficiency and morale. Historically, within busy surgical firms the most junior team members commonly worked beyond scheduled hours. It has been highlighted within our trust that our IT systems significantly contributed to this. Thus leading to the creation of a clinician-led IT solution, enabling direct access to accurate information at a single point.  This study aims to measure the impact of the systems introduction on efficiency and shift experience of our junior doctors.  Methods 'Clinical Portal’ was introduced in August 2019. This IT system enables all patient information to be collated in one place, with the added benefit of simplifying the creation of patient lists. Number and duration of Exception Reports (ER) by on-call surgical juniors were measured for two months pre and post intervention. A qualitative survey was also distributed to this cohort to measure satisfaction and experience during on-call shifts within this period.  Results Following introduction of 'Clinical Portal', the total length of time included in ERs reduced. Surgical juniors expressed an improvement in their on-call experience, most notably dedicating less time to collating patient information and ward list formation. The overall experience improved despite time required to become proficient at using the new system.  Conclusions Streamlining of IT systems used during on-call shifts demonstrates improved efficiency amongst juniors reflected in a reduction of ERs. A direct consequence of these implemented changes is significant improvement in morale amongst our juniors. 

Caritas Education: Theory to Practice

2020 ◽  
Vol 24 (2) ◽  
pp. 106-120
Author(s):  
Kim Rossillo ◽  
Vivian Norman ◽  
Mary Wickman ◽  
Elizabeth Winokur
Keyword(s):  
Self Efficacy ◽  
Care Delivery ◽  
Post Intervention ◽  
Convenience Sample ◽  
Caring Behaviors ◽  
Theory To Practice ◽  
Newly Graduated Nurses ◽  
Theory Of Human Caring ◽  
Human Caring ◽  
The Impact

Increasingly complex occupational demands along with varied educational and personal examples of caring, may impact the ability to deeply connect with patients. Literature has identified that nurses and patients have differing perceptions of caring behaviors. Jean Watson's Theory of Human Caring provides a framework for care delivery that focuses on the caring nurse–patient relationship and the experience through the patients' lens.Caring healing relationships are at the core of professional nursing. The purpose of this project was to design and deliver an educational seminar based on Jean Watson's Theory of Human Caring to newly graduated nurses to examine the impact on self-efficacy in caring behaviors.The project participants (N = 56) consisted of a nonprobability convenience sample of newly graduated nurses at a local faith-based community hospital. The educational intervention consisted of experiential learning activities to facilitate translating theory to practice. The study utilized the Caring Efficacy Scale (CES), which is an instrument based on Watson's caring theory and Albert Bandura's self-efficacy theory. Results demonstrated a significant improvement in caring efficacy between the preintervention (M = 5.1, SD = .47), and immediate post intervention (M = 5.5, SD = .38); t (52) = −9.09, p = .000.The knowledge from this study could provide insights for the development of effective teaching strategies to facilitate translating nursing theory to practice. Establishing and developing skills to facilitate nurturing, caring nurse–patient relationships may enhance both the patient and caregiver experience.

scholarly journals Consensus and variations in opinions on delirium care: a survey of European delirium specialists

2013 ◽  
Vol 25 (12) ◽  
pp. 2067-2075 ◽  
Author(s):  
A. Morandi ◽  
D. Davis ◽  
J. K. Taylor ◽  
G. Bellelli ◽  
B. Olofsson ◽  
...  
Keyword(s):  
Best Practice ◽  
Online Survey ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
First Line ◽  
Pharmacological Management ◽  
Medical Need ◽  
Hypoactive Delirium

ABSTRACTBackground:There are still substantial uncertainties over best practice in delirium care. The European Delirium Association (EDA) conducted a survey of its members and other interested parties on various aspects of delirium care.Methods:The invitation to participate in the online survey was distributed among the EDA membership. The survey covered assessment, treatment of hyperactive and hypoactive delirium, and organizational management.Results:A total of 200 responses were collected (United Kingdom 28.6%, Netherlands 25.3%, Italy 15%, Switzerland 9.7%, Germany 7.1%, Spain 3.8%, Portugal 2.5%, Ireland 2.5%, Sweden 0.6%, Denmark 0.6%, Austria 0.6%, and others 3.2%). Most of the responders were doctors (80%), working in geriatrics (45%) or internal medicine (14%). Ninety-two per cent of the responders assessed patients for delirium daily. The most commonly used assessment tools were the Confusion Assessment Method (52%) and the Delirium Observation Screening Scale (30%). The first-line choice in the management of hyperactive delirium was a combination of non-pharmacological and pharmacological approaches (61%). Conversely, non-pharmacological management was the first-line choice in hypoactive delirium (67%). Delirium awareness (34%), knowledge (33%), and lack of education (13%) were the most commonly reported barriers to improving the detection of delirium. Interestingly, 63% of the responders referred patients after an episode of delirium to a follow-up clinic.Conclusions:This is the first systematic survey involving an international group of specialists in delirium. Several areas of lack of consensus were found. These results emphasise the importance of further research to improve care of this major unmet medical need.

scholarly journals Effects of Depression, Dementia and Delirium on Activities of Daily Living in Elderly Patients after Discharge

2019 ◽  
Author(s):  
Ching Fu Weng ◽  
Kun-Pei Lin ◽  
Feng-Ping Lu ◽  
Jen-Hau Chen ◽  
Chiung-Jung Wen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Short Form ◽  
Medical Center ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
The Impact

Abstract Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients aged 65 years and older admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. There were significant lower BI scores in patients with dementia and delirium compared with those without up to 180 days after discharge, but no difference was seen in the depression group. In general, patients had delirium or dementia had worsening functional status, even though significant magnitude of improvements on BI scores after discharge. Conclusions Depression does not affect patients’ ADLs. On the other hand, dementia and delirium can persistently limit patients’ physical function. Future care should focus more on dementia and delirium to restore function.

scholarly journals DELIRIUM SEVERITY AND COGNITIVE OUTCOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S921-S921
Author(s):  
Sarah A Welch ◽  
E Wesley Ely ◽  
Jin H Han
Keyword(s):  
Severity Of Illness ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Outcomes ◽  
Illness Cognition ◽  
Point Increase ◽  
Comorbidity Burden ◽  
Factor Interactions ◽  
The Impact

Abstract Delirium is heterogeneous and can vary by severity. The impact of its severity is unclear. This prospective cohort study enrolled emergency department (ED) patients who were &gt; 65 years old and admitted to the hospital. Delirium severity was determined by the Confusion Assessment Method for the Intensive Care Unit Severity (CAM-ICU-S) Scale measured at enrollment. This scale ranges from 0 (no symptoms) to 7 (most severe). Premorbid and 6-month cognition were determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranges from 1 to 5 (severe cognitive impairment). Multiple linear regression was performed to determine if delirium severity was associated with 6-month function and cognition adjusted for pre-illness IQCODE, baseline functional status, comorbidity burden, severity of illness, and central nervous system diagnosis. Two-factor interactions were incorporated to determine if pre-illness cognition modified the relationship between delirium severity as measured by the CAM-ICU-S and 6-month cognition. A total of 228 older patients were enrolled in the ED and of these, 105 were delirious. Median (interquartile range) CAM-ICU-S scores was 2 (0, 5). In patients with intact pre-illness cognition, a point increase in the CAM-ICU-S significantly increased the 6-month IQCODE by 0.06 (95%CI: 0.01 to 0.12) points. In patients with impaired pre-illness cognition, there was no significant association between the CAM-ICU-S and 6-month IQCODE. Thus delirium severity is associated with poorer 6-month cognition, but this association is more prominent in those with intact pre-illness cognition.

Functional and cognitive decline in older delirious adults after an emergency department visit

2020 ◽  
Author(s):  
Marianne Giroux ◽  
Marcel Émond ◽  
Alexandra Nadeau ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Status ◽  
Confusion Assessment ◽  
Lower Baseline ◽  
A Minor ◽  
The Impact ◽  
Minor Improvement

Abstract Background the aim of this study was to evaluate the impact of emergency department (ED) stay-associated delirium on older patient’s functional and cognitive status at 60 days post ED visit. Methods this study was part of the multi-centre prospective cohort INDEED study. This project took place between March 2015 and July 2016 in five participating EDs across the province of Quebec. Independent non-delirious patients aged ≥65, with an ED stay ≥8 hours, were monitored for delirium until 24 hours post ward admission. A 60-day follow-up phone assessment was conducted. Participants were screened for delirium using the Confusion Assessment Method. Functional and cognitive statuses were assessed at baseline and at the 60-day follow-up using OARS and TICS-m. Results a total of 608 patients were recruited, 393 of which completed the 60-day follow-up. The Confusion Assessment Method was positive in 69 patients (11.8%) during ED stay or within the first 24 hours following ward admission. At 60 days, delirium patients experienced an adjusted loss of −2.9/28 [95%CI: −3.9, −2.0] points on the OARS scale compared to non-delirious patients who lost −1.6 [95%CI: −1.9, −1.3] (P = 0.006). A significant adjusted difference in cognitive function was also noted at 60 days, as TICS-m scores in delirious patients decreased by −1.6 [95%CI: −3.5, 0.2] compared to non-delirious patients, who showed a minor improvement of 0.5 [95%CI: −0.1, 1.1] (P = 0.03). Conclusion seniors who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients, and they will experience a more significant decline at 60 days post ED visit.

scholarly journals Effects of Depression, Dementia and Delirium on Activities of Daily Living in Elderly Patients after Discharge

2019 ◽  
Author(s):  
Ching Fu Weng ◽  
Kun-Pei Lin ◽  
Feng-Ping Lu ◽  
Jen-Hau Chen ◽  
Chiung-Jung Wen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Short Form ◽  
Medical Center ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
The Impact

Abstract Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients aged 65 years and older admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. There were significant lower BI scores in patients with dementia and delirium compared with those without up to 180 days after discharge, but no difference was seen in the depression group. In general, patients had delirium or dementia had worsening functional status, even though significant magnitude of improvements on BI scores after discharge. Conclusions Depression does not affect patients’ ADLs. On the other hand, dementia and delirium can persistently limit patients’ physical function. Future care should focus more on dementia and delirium to restore function.

scholarly journals LO70: Functional & cognitive decline in older delirious adults after an emergency department visit

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S33
Author(s):  
M. Giroux ◽  
M. Sirois ◽  
A. Nadeau ◽  
V. Boucher ◽  
P. Carmichael ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cognitive Decline ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Status ◽  
Cognitive Outcomes ◽  
Negative Consequences ◽  
Significant Difference ◽  
The Impact

Introduction: While negative consequences of incident delirium on functional and cognitive decline have been widely studied, very limited data is available regarding functional and cognitive outcomes in Emergency Department (ED) patients. The aim of this study was therefore to evaluate the impact of ED stay-associated delirium on older patient's functional and cognitive status at 60 days post-ED visit. Methods: This study is a planned sub-analysis of a large multicentre prospective cohort study (the INDEED study). This project took place between March and July of the years 2015 and 2016 within 5 participating EDs across the province of Quebec. Independent non-delirious patients aged □65, with an ED stay at least 8hrs were monitored until 24hrs post-ward admission. A 60-day follow-up phone assessment was also conducted. Participants were screened for delirium using the validated Confusion Assessment Method (CAM) and the severity of its symptoms was measured using the Delirium Index. Functional and cognitive status were assessed at baseline as well as at the 60-day follow-up using the validated OARS and TICS-m. Results: A total of 608 patients were recruited, 393 of which completed the 60-day follow-up. Sixty-nine patients obtained a positive CAM during ED-stay or within the first 24 hours following ward admission. At 60-days, those patients experienced a loss of 3.1 (S.D. 4.0) points on the OARS scale compared to non-delirious patients who lost 1.6 (S.D. 3.0) (p = 0.03). A significant difference in cognitive function was also noted at 60-days, as delirious patients’ TICS-m score decreased by 2.1 (S.D. 6.2) compared to non-delirious patients, who showed a minor improvement of 0.5 (S.D. 5.8) (p = 0.01). Conclusion: People who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients and they will experience a more significant decline at 60 days post-ED visit.

scholarly journals Delirium in Australian Hospitals: A Prospective Study

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
C. Travers ◽  
G. J. Byrne ◽  
N. A. Pachana ◽  
K. Klein ◽  
L. Gray
Keyword(s):  
Older Patients ◽  
Prospective Observational Study ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Adverse Outcomes ◽  
Confusion Assessment ◽  
Hospital Patients ◽  
Research Nurses ◽  
High Index Of Suspicion ◽  
A Prospective Study

Objectives. Australian data regarding delirium in older hospitalized patients are limited. Hence, this study aimed to determine the prevalence and incidence of delirium among older patients admitted to Australian hospitals and assess associated outcomes.Method. A prospective observational study (n=493) of patients aged ≥70 years admitted to four Australian hospitals was undertaken. Trained research nurses completed comprehensive geriatric assessments using standardized instruments including the Confusion Assessment Method to assess for delirium. Nurses also visited the wards daily to assess for incident delirium and other adverse outcomes. Diagnoses of dementia and delirium were established through case reviews by independent physicians.Results. Overall, 9.7% of patients had delirium at admission and a further 7.6% developed delirium during the hospital stay. Dementia was the most important predictor of delirium at (OR=3.18, 95% CI: 1.65–6.14) and during the admission (OR=4.82; 95% CI: 2.19–10.62). Delirium at and during the admission predicted increased in-hospital mortality (OR=5.19, 95% CI: 1.27–21.24;OR=31.07, 95% CI: 9.30–103.78).Conclusion.These Australian data confirm that delirium is a common and serious condition among older hospital patients. Hospital clinicians should maintain a high index of suspicion for delirium in older patients.

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