Zahra Azizi, Niamh A. O'Regan, T. Dukelow, Teresa Bohane, Eithne Harkin, Christina Donnellan, Ida Carroll, Maria Costello, Susan O'Reilly, Claire Noonan, Erica Walsh, Suzanne Timmons
Delirium is an encephalopathy characterized by acute onset, fluctuation, and prominent deficits in attention and alertness, due to one or more physical disorders, interventions or medications. It is associated with increased mortality and morbidity, and with incidence and worsening of dementia; thus, delirium prevention and timely detection and appropriate management are crucial. This study aimed to determine delirium prevalence in Irish clinical sites. The overall study was an observational, cohort study of the point prevalence of delirium (and current delirium practice) in multiple clinical sites on a single day (i.e. World Delirium Awareness Day, March 2023). In this study, the point prevalence of delirium is reported in Irish sites. In total, 132 wards from 15 hospitals across Ireland participated in this study, including general medical, surgical and specialised wards, and some long-term care and rehabilitation wards. Overall, 27% of patients on wards which reported using a formal tool had not been assessed for delirium. Delirium prevalence, using a formal assessment tool, was 15.9% overall, with the highest rate in geriatric wards (20.5%). However, on wards where ‘personal judgment’ to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may have been under-detected on these wards. Delirium screening can quickly rule out delirium or lead to more formal assessment where screening is positive or equivocal. Delirium is prevalent in Irish hospitals and appears to be under-detected unless a formal screening tool is used; equally, delirium screening is not universally applied on wards reporting that they use a formal tool. Together, this indicates that delirium is still under-diagnosed in Irish hospitals.
{"title":"Informal judgement of delirium status underestimates delirium prevalence: World Delirium Awareness Day point prevalence results from Ireland","authors":"Zahra Azizi, Niamh A. O'Regan, T. Dukelow, Teresa Bohane, Eithne Harkin, Christina Donnellan, Ida Carroll, Maria Costello, Susan O'Reilly, Claire Noonan, Erica Walsh, Suzanne Timmons","doi":"10.56392/001c.92222","DOIUrl":"https://doi.org/10.56392/001c.92222","url":null,"abstract":"Delirium is an encephalopathy characterized by acute onset, fluctuation, and prominent deficits in attention and alertness, due to one or more physical disorders, interventions or medications. It is associated with increased mortality and morbidity, and with incidence and worsening of dementia; thus, delirium prevention and timely detection and appropriate management are crucial. This study aimed to determine delirium prevalence in Irish clinical sites. The overall study was an observational, cohort study of the point prevalence of delirium (and current delirium practice) in multiple clinical sites on a single day (i.e. World Delirium Awareness Day, March 2023). In this study, the point prevalence of delirium is reported in Irish sites. In total, 132 wards from 15 hospitals across Ireland participated in this study, including general medical, surgical and specialised wards, and some long-term care and rehabilitation wards. Overall, 27% of patients on wards which reported using a formal tool had not been assessed for delirium. Delirium prevalence, using a formal assessment tool, was 15.9% overall, with the highest rate in geriatric wards (20.5%). However, on wards where ‘personal judgment’ to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may have been under-detected on these wards. Delirium screening can quickly rule out delirium or lead to more formal assessment where screening is positive or equivocal. Delirium is prevalent in Irish hospitals and appears to be under-detected unless a formal screening tool is used; equally, delirium screening is not universally applied on wards reporting that they use a formal tool. Together, this indicates that delirium is still under-diagnosed in Irish hospitals.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"77 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. A. Austin, Imani Bazemore, Joe Yi, Sarah Glier, Shannon S. Carson
Postoperative delirium is a prevalent condition associated with increased mortality, difficulties with physical recovery from surgery and decreased long-term cognitive function, especially in older adults. Currently, there are no direct medical treatments for delirium. We recently found an association between SSRI administration and reduced delirium in a critically ill medical population. We sought to evaluate this association in a surgical population. SSRIs may provide a new treatment option for delirium; further exploration is warranted. We aimed to assess the association between selective serotonin reuptake inhibitors (SSRIs) and delirium in postoperative adults. We undertook a secondary analysis of an existing cohort in a large Academic Medical Centre in the Southeast United States. Patients were adults (aged 18-99) requiring at least one night of hospital admission following a scheduled surgery, enrolled from July 2017 to September 2017. Our primary outcome was the incidence of delirium 24 hours after administration of an SSRI. Our exposure variable was any SSRI administration in the preceding 24 hours. We collected data on demographics, SSRI administration, overall severity of illness via the ASA grading system, and daily severity of illness via the Sequential Organ Failure Assessment (SOFA) score from the electronic medical record review. We collected data on 191 patients (mean age 56.8 years, SD +/- 16.7). One hundred ten (57.6%) were female, and 149 (78%) were White. Most patients, 183 (95.8%), were non-Hispanic. Twenty-eight (14.6%) were prescribed SSRIs at any point during the study period and 35 (18.3%) were delirious on day one. Unadjusted analysis demonstrated that patients receiving SSRIs had OR 1.60 for delirium the next day (p=0.41). After adjusting for age ASA, age, hospital LOS, and SOFA, patients receiving SSRIs had OR 1.44 for next-day delirium (p=0.48). SSRIs administered in the postoperative period were not associated with delirium on the subsequent day. This finding conflicts with prior results from a critically ill population. The association of SSRIs with delirium requires further investigation.
{"title":"The Association of Selective Serotonin Reuptake Inhibitors with Delirium in Post-Operative Adults: A Secondary Analysis of a Post-Operative Dataset with Daily Severity of Illness Adjustment","authors":"C. A. Austin, Imani Bazemore, Joe Yi, Sarah Glier, Shannon S. Carson","doi":"10.56392/001c.94253","DOIUrl":"https://doi.org/10.56392/001c.94253","url":null,"abstract":"Postoperative delirium is a prevalent condition associated with increased mortality, difficulties with physical recovery from surgery and decreased long-term cognitive function, especially in older adults. Currently, there are no direct medical treatments for delirium. We recently found an association between SSRI administration and reduced delirium in a critically ill medical population. We sought to evaluate this association in a surgical population. SSRIs may provide a new treatment option for delirium; further exploration is warranted. We aimed to assess the association between selective serotonin reuptake inhibitors (SSRIs) and delirium in postoperative adults. We undertook a secondary analysis of an existing cohort in a large Academic Medical Centre in the Southeast United States. Patients were adults (aged 18-99) requiring at least one night of hospital admission following a scheduled surgery, enrolled from July 2017 to September 2017. Our primary outcome was the incidence of delirium 24 hours after administration of an SSRI. Our exposure variable was any SSRI administration in the preceding 24 hours. We collected data on demographics, SSRI administration, overall severity of illness via the ASA grading system, and daily severity of illness via the Sequential Organ Failure Assessment (SOFA) score from the electronic medical record review. We collected data on 191 patients (mean age 56.8 years, SD +/- 16.7). One hundred ten (57.6%) were female, and 149 (78%) were White. Most patients, 183 (95.8%), were non-Hispanic. Twenty-eight (14.6%) were prescribed SSRIs at any point during the study period and 35 (18.3%) were delirious on day one. Unadjusted analysis demonstrated that patients receiving SSRIs had OR 1.60 for delirium the next day (p=0.41). After adjusting for age ASA, age, hospital LOS, and SOFA, patients receiving SSRIs had OR 1.44 for next-day delirium (p=0.48). SSRIs administered in the postoperative period were not associated with delirium on the subsequent day. This finding conflicts with prior results from a critically ill population. The association of SSRIs with delirium requires further investigation.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"44 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141103804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nameer van Oosterom, M. R. Agar, Grace Walpole, Penelope Casey, Paula Moffat, Keiron Bradley, A. Cook, Claire E. Johnson, Richard Chye, Jacqueline Oehme, Maria Senatore, Claudia Virdun, Mark Pearson, I. Featherstone, Peter G. Lawlor, S. Bush, Barb Daveson, S. Clapham, Kimberley M Campbell, A. Hosie
Introduction Delirium is a serious acute neurocognitive condition that is common in palliative care units and yet under-addressed. To improve delirium care in this setting, we will develop and pilot a monitoring system that integrates the Delirium Clinical Care Standard, Palliative Care Outcomes Collaboration (PCOC) methods, and perspectives of patients, carers and staff. Methods This paper reports the protocol for a two-stage, exploratory, sequential mixed-methods implementation study. Stage 1 data collection includes Delirium Standard-aligned process mapping and clinical audits, and Critical Incident Technique interviews with patients, carers and staff with a recent experience of delirium. We will present integrated stage 1 findings to stakeholders then collaboratively develop a delirium monitoring system that aligns with the Delirium Standard and PCOC methods. In stage 2, we will pilot the new system and repeat stage 1 data collection and analyses, adding PCOC and adverse event measures. Implementation principles and strategies such as audit and feedback and education will be applied. We developed simplified participants information sheets and consent forms for interview and process mapping participants, who will provide written informed consent; and waiver of consent to collect clinical audit, PCOC and adverse event data from patients’ medical records is approved. At study end, we will report implementation, effectiveness and safety outcomes, including systemic utility of the delirium monitoring system for wider testing and use to meet the Delirium Standard in palliative care units. Quantitative data analyses will include descriptive and inferential statistics and qualitative analyses will incorporate thematic content analysis aligned to the Critical Incident Technique. Mixed methods data integration will be at the end of each stage. Discussion This protocol paper describes the mixed methods, systems integration, and innovative measures and study processes of the MODEL-PC study. We also share data collection tools and a simplified information sheet and consent form for patients.
{"title":"Driving quality in delirium care through a patient-centered monitoring system in palliative care: Protocol for the two-staged exploratory sequential mixed methods MODEL-PC study","authors":"Nameer van Oosterom, M. R. Agar, Grace Walpole, Penelope Casey, Paula Moffat, Keiron Bradley, A. Cook, Claire E. Johnson, Richard Chye, Jacqueline Oehme, Maria Senatore, Claudia Virdun, Mark Pearson, I. Featherstone, Peter G. Lawlor, S. Bush, Barb Daveson, S. Clapham, Kimberley M Campbell, A. Hosie","doi":"10.56392/001c.94808","DOIUrl":"https://doi.org/10.56392/001c.94808","url":null,"abstract":"Introduction Delirium is a serious acute neurocognitive condition that is common in palliative care units and yet under-addressed. To improve delirium care in this setting, we will develop and pilot a monitoring system that integrates the Delirium Clinical Care Standard, Palliative Care Outcomes Collaboration (PCOC) methods, and perspectives of patients, carers and staff. Methods This paper reports the protocol for a two-stage, exploratory, sequential mixed-methods implementation study. Stage 1 data collection includes Delirium Standard-aligned process mapping and clinical audits, and Critical Incident Technique interviews with patients, carers and staff with a recent experience of delirium. We will present integrated stage 1 findings to stakeholders then collaboratively develop a delirium monitoring system that aligns with the Delirium Standard and PCOC methods. In stage 2, we will pilot the new system and repeat stage 1 data collection and analyses, adding PCOC and adverse event measures. Implementation principles and strategies such as audit and feedback and education will be applied. We developed simplified participants information sheets and consent forms for interview and process mapping participants, who will provide written informed consent; and waiver of consent to collect clinical audit, PCOC and adverse event data from patients’ medical records is approved. At study end, we will report implementation, effectiveness and safety outcomes, including systemic utility of the delirium monitoring system for wider testing and use to meet the Delirium Standard in palliative care units. Quantitative data analyses will include descriptive and inferential statistics and qualitative analyses will incorporate thematic content analysis aligned to the Critical Incident Technique. Mixed methods data integration will be at the end of each stage. Discussion This protocol paper describes the mixed methods, systems integration, and innovative measures and study processes of the MODEL-PC study. We also share data collection tools and a simplified information sheet and consent form for patients.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":" 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Florian Schimböck, Volkmar Hanisch, Ulf Günther, Hans-Christian Hansen, Rebecca von Haken, Carsten Hermes, Carolin Hoyer, Arnold Kaltwasser, Sabrina Pelz, Peter Nydahl
Implementation of delirium management in hospitals is a complex process, often challenging and requiring interprofessional and interdisciplinary communication and collaboration. This project aimed to assess whether a delirium-specific interprofessional education (IPE) course would empower clinicians to conduct quality improvement projects in their hospital. Quality-improvement project in a university-affiliated hospital. Clinicians (physicians, nurses, and therapists) attended a 2-day IPE course for delirium management certified by the German Society of Intensive Care Medicine. Participants developed projects for quality improvement and presented results in a meeting eight weeks later. In total, 16 clinicians (eight nurses, six therapists, two physicians) from six wards participated. Participants organised themselves into five project groups. Eight weeks after attending the training, four out of five groups presented projects with successful and ongoing implementation, such as establishing a hospital delirium expert panel, delirium flyers for relatives, an informational one-pager for clinicians across the hospital, and a teaching concept for training of therapists. Implementing the 4AT delirium assessment in electronic patient charts took longer, extending beyond the 8-week timeframe. Overall, clinicians were satisfied with the IPE course and reported they felt more competent to care for delirious patients. The delirium IPE course motivated and enabled participating clinicians to develop and perform delirium-specific quality-improvement projects in their hospital. Further research is needed to evaluate the sustainability of these projects and to estimate the effect of influencing factors within the context of the culture and setting.
{"title":"Interprofessional Education for Delirium Management: a Quality Improvement Project","authors":"Florian Schimböck, Volkmar Hanisch, Ulf Günther, Hans-Christian Hansen, Rebecca von Haken, Carsten Hermes, Carolin Hoyer, Arnold Kaltwasser, Sabrina Pelz, Peter Nydahl","doi":"10.56392/001c.92850","DOIUrl":"https://doi.org/10.56392/001c.92850","url":null,"abstract":"Implementation of delirium management in hospitals is a complex process, often challenging and requiring interprofessional and interdisciplinary communication and collaboration. This project aimed to assess whether a delirium-specific interprofessional education (IPE) course would empower clinicians to conduct quality improvement projects in their hospital. Quality-improvement project in a university-affiliated hospital. Clinicians (physicians, nurses, and therapists) attended a 2-day IPE course for delirium management certified by the German Society of Intensive Care Medicine. Participants developed projects for quality improvement and presented results in a meeting eight weeks later. In total, 16 clinicians (eight nurses, six therapists, two physicians) from six wards participated. Participants organised themselves into five project groups. Eight weeks after attending the training, four out of five groups presented projects with successful and ongoing implementation, such as establishing a hospital delirium expert panel, delirium flyers for relatives, an informational one-pager for clinicians across the hospital, and a teaching concept for training of therapists. Implementing the 4AT delirium assessment in electronic patient charts took longer, extending beyond the 8-week timeframe. Overall, clinicians were satisfied with the IPE course and reported they felt more competent to care for delirious patients. The delirium IPE course motivated and enabled participating clinicians to develop and perform delirium-specific quality-improvement projects in their hospital. Further research is needed to evaluate the sustainability of these projects and to estimate the effect of influencing factors within the context of the culture and setting.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139959239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Nydahl, Friederike Baumgarte, Daniela Berg, Christoph Borzikowsky, Diana Green, Anisa Hannig, Hans-Christian Hansen, Uta Hansen, Rahel Istel, Norma Krämer, Karita Krause, Mohammad Mohammadzadeh-Vazifeh, Jürgen Osterbrink, Frederick Palm, Telse Petersen, Fidan Rasmussen, Bernd Schöller, Henning Stolze, J. Meyne, Nils G Margraf
During the covid-19 pandemic, a non-funded, nurse-led quality improvement project on delirium management was in progress on four Stroke Units (SU). Two sites experienced pandemic-related delays; we set out to learn lessons based on the impact for delivering multicentre trials. Secondary analysis of a prospective quality improvement project. We compared data quality from centres with vs. without delay. Unplanned modifications in study management were classified as a) fatal modifications (ending the study), b) serious modifications (requiring a revision of the registration and/or ethic approval, c) moderate modifications (revising study management), d) minor modifications (improving study performance). Local study coordinators summarised lessons learned. The study had an overall delay of 14 months. Centres without delay delivered better data quality and had less loss of patients due to missing primary outcome data in 0.3% vs 28.8% in centres with delay (p<0.001). There were no fatal modifications, two serious (exchange of study centre, adding new outcome parameters), six moderate (e.g. delayed start in two centres, change from in-person to virtual meetings), and one minor modification (four local study coordinators taking parental leave). Lessons learned were frequent communication with study coordinators, attention to data quality, protocolisation of recruitment rates, and adapted education in quality improvement projects. Pandemic-related disruption can be substantial, with poorer data quality, but only in a few cases were registration and/or ethic approval modifications required. Facilitators are flexible, including changed time frames, frequent virtual communication, and critical reflection.
{"title":"Implementation of delirium management during the pandemic: lessons learned","authors":"Peter Nydahl, Friederike Baumgarte, Daniela Berg, Christoph Borzikowsky, Diana Green, Anisa Hannig, Hans-Christian Hansen, Uta Hansen, Rahel Istel, Norma Krämer, Karita Krause, Mohammad Mohammadzadeh-Vazifeh, Jürgen Osterbrink, Frederick Palm, Telse Petersen, Fidan Rasmussen, Bernd Schöller, Henning Stolze, J. Meyne, Nils G Margraf","doi":"10.56392/001c.92852","DOIUrl":"https://doi.org/10.56392/001c.92852","url":null,"abstract":"During the covid-19 pandemic, a non-funded, nurse-led quality improvement project on delirium management was in progress on four Stroke Units (SU). Two sites experienced pandemic-related delays; we set out to learn lessons based on the impact for delivering multicentre trials. Secondary analysis of a prospective quality improvement project. We compared data quality from centres with vs. without delay. Unplanned modifications in study management were classified as a) fatal modifications (ending the study), b) serious modifications (requiring a revision of the registration and/or ethic approval, c) moderate modifications (revising study management), d) minor modifications (improving study performance). Local study coordinators summarised lessons learned. The study had an overall delay of 14 months. Centres without delay delivered better data quality and had less loss of patients due to missing primary outcome data in 0.3% vs 28.8% in centres with delay (p<0.001). There were no fatal modifications, two serious (exchange of study centre, adding new outcome parameters), six moderate (e.g. delayed start in two centres, change from in-person to virtual meetings), and one minor modification (four local study coordinators taking parental leave). Lessons learned were frequent communication with study coordinators, attention to data quality, protocolisation of recruitment rates, and adapted education in quality improvement projects. Pandemic-related disruption can be substantial, with poorer data quality, but only in a few cases were registration and/or ethic approval modifications required. Facilitators are flexible, including changed time frames, frequent virtual communication, and critical reflection.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"8 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139959555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tru Byrnes, Meridith Gombar, Sarah Price, Allyson Cochran, Karrie Love, Amanda Gregory, Veronica Rankin, Katrina Daye-Whitehead
Delirium is an acute change in mental status that affects more than 2.6 million hospitalised adults annually. Patients who experience delirium suffer extended hospital stays and increased mortality and morbidity. Delirium screening is fundamental in driving prevention and early detection. This project aimed to examine delirium assessment, recognition for patients over 18, barriers to implementing delirium prevention treatment, and report qualitative findings for delirium care. In mid-March 2023, 11 Clinical Nurse Leaders in the Southeast Region of the United States participated in a study to increase awareness of delirium called World Delirium Awareness Day. Data was collected using an online survey to assess unit census, the number of CAM assessments, and positive CAM screening at 8:00 A.M (+/- 4 hrs) and 8:00 PM (+/- 4 hrs). Patients were defined as having delirium if their electronic healthcare record documentation reflected at least one occurrence of a positive CAM score. The survey comprised 39 “select all that apply” questions and three open-ended questions. Results show 418 (64%) CAM assessments were completed. Greater compliance was found during the morning assessment than the evening shift. Differences in nursing practice and opinions were also identified between General and High Acuity Units. Among patients receiving assessments, delirium recognition was 2% (8:00 A.M.) and 3% (8:00 P.M.). There was a significant difference in the use of multi-professional daily goals between the two unit types as a non-pharmacologic intervention for delirium (General: 0% vs. High Acuity: 100%, p=.003). Barriers identified: shortage of personnel, interprofessional communication gaps, and difficult-to-assess patients. Recommendations for delirium care include staff education and implementing an EHR tool to remind nurses to assess and document delirium. Findings from this study reveal the need for staff education, support, and the enhancement of resources to promote delirium prevention.
{"title":"Delirium is Under-Detected on Routine Screening with the CAM: a Sub-Study from World Delirium Awareness Day","authors":"Tru Byrnes, Meridith Gombar, Sarah Price, Allyson Cochran, Karrie Love, Amanda Gregory, Veronica Rankin, Katrina Daye-Whitehead","doi":"10.56392/001c.92219","DOIUrl":"https://doi.org/10.56392/001c.92219","url":null,"abstract":"Delirium is an acute change in mental status that affects more than 2.6 million hospitalised adults annually. Patients who experience delirium suffer extended hospital stays and increased mortality and morbidity. Delirium screening is fundamental in driving prevention and early detection. This project aimed to examine delirium assessment, recognition for patients over 18, barriers to implementing delirium prevention treatment, and report qualitative findings for delirium care. In mid-March 2023, 11 Clinical Nurse Leaders in the Southeast Region of the United States participated in a study to increase awareness of delirium called World Delirium Awareness Day. Data was collected using an online survey to assess unit census, the number of CAM assessments, and positive CAM screening at 8:00 A.M (+/- 4 hrs) and 8:00 PM (+/- 4 hrs). Patients were defined as having delirium if their electronic healthcare record documentation reflected at least one occurrence of a positive CAM score. The survey comprised 39 “select all that apply” questions and three open-ended questions. Results show 418 (64%) CAM assessments were completed. Greater compliance was found during the morning assessment than the evening shift. Differences in nursing practice and opinions were also identified between General and High Acuity Units. Among patients receiving assessments, delirium recognition was 2% (8:00 A.M.) and 3% (8:00 P.M.). There was a significant difference in the use of multi-professional daily goals between the two unit types as a non-pharmacologic intervention for delirium (General: 0% vs. High Acuity: 100%, p=.003). Barriers identified: shortage of personnel, interprofessional communication gaps, and difficult-to-assess patients. Recommendations for delirium care include staff education and implementing an EHR tool to remind nurses to assess and document delirium. Findings from this study reveal the need for staff education, support, and the enhancement of resources to promote delirium prevention.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"25 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139804308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tru Byrnes, Meridith Gombar, Sarah Price, Allyson Cochran, Karrie Love, Amanda Gregory, Veronica Rankin, Katrina Daye-Whitehead
Delirium is an acute change in mental status that affects more than 2.6 million hospitalised adults annually. Patients who experience delirium suffer extended hospital stays and increased mortality and morbidity. Delirium screening is fundamental in driving prevention and early detection. This project aimed to examine delirium assessment, recognition for patients over 18, barriers to implementing delirium prevention treatment, and report qualitative findings for delirium care. In mid-March 2023, 11 Clinical Nurse Leaders in the Southeast Region of the United States participated in a study to increase awareness of delirium called World Delirium Awareness Day. Data was collected using an online survey to assess unit census, the number of CAM assessments, and positive CAM screening at 8:00 A.M (+/- 4 hrs) and 8:00 PM (+/- 4 hrs). Patients were defined as having delirium if their electronic healthcare record documentation reflected at least one occurrence of a positive CAM score. The survey comprised 39 “select all that apply” questions and three open-ended questions. Results show 418 (64%) CAM assessments were completed. Greater compliance was found during the morning assessment than the evening shift. Differences in nursing practice and opinions were also identified between General and High Acuity Units. Among patients receiving assessments, delirium recognition was 2% (8:00 A.M.) and 3% (8:00 P.M.). There was a significant difference in the use of multi-professional daily goals between the two unit types as a non-pharmacologic intervention for delirium (General: 0% vs. High Acuity: 100%, p=.003). Barriers identified: shortage of personnel, interprofessional communication gaps, and difficult-to-assess patients. Recommendations for delirium care include staff education and implementing an EHR tool to remind nurses to assess and document delirium. Findings from this study reveal the need for staff education, support, and the enhancement of resources to promote delirium prevention.
{"title":"Delirium is Under-Detected on Routine Screening with the CAM: a Sub-Study from World Delirium Awareness Day","authors":"Tru Byrnes, Meridith Gombar, Sarah Price, Allyson Cochran, Karrie Love, Amanda Gregory, Veronica Rankin, Katrina Daye-Whitehead","doi":"10.56392/001c.92219","DOIUrl":"https://doi.org/10.56392/001c.92219","url":null,"abstract":"Delirium is an acute change in mental status that affects more than 2.6 million hospitalised adults annually. Patients who experience delirium suffer extended hospital stays and increased mortality and morbidity. Delirium screening is fundamental in driving prevention and early detection. This project aimed to examine delirium assessment, recognition for patients over 18, barriers to implementing delirium prevention treatment, and report qualitative findings for delirium care. In mid-March 2023, 11 Clinical Nurse Leaders in the Southeast Region of the United States participated in a study to increase awareness of delirium called World Delirium Awareness Day. Data was collected using an online survey to assess unit census, the number of CAM assessments, and positive CAM screening at 8:00 A.M (+/- 4 hrs) and 8:00 PM (+/- 4 hrs). Patients were defined as having delirium if their electronic healthcare record documentation reflected at least one occurrence of a positive CAM score. The survey comprised 39 “select all that apply” questions and three open-ended questions. Results show 418 (64%) CAM assessments were completed. Greater compliance was found during the morning assessment than the evening shift. Differences in nursing practice and opinions were also identified between General and High Acuity Units. Among patients receiving assessments, delirium recognition was 2% (8:00 A.M.) and 3% (8:00 P.M.). There was a significant difference in the use of multi-professional daily goals between the two unit types as a non-pharmacologic intervention for delirium (General: 0% vs. High Acuity: 100%, p=.003). Barriers identified: shortage of personnel, interprofessional communication gaps, and difficult-to-assess patients. Recommendations for delirium care include staff education and implementing an EHR tool to remind nurses to assess and document delirium. Findings from this study reveal the need for staff education, support, and the enhancement of resources to promote delirium prevention.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"16 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139864297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine Waszynski, Jeanne Kessler, Jyoti Chhabra, Thomas Nowicki, Shelby Greco
Delirium is a common and under-recognized condition affecting patients during times of illness or injury and is associated with poor short and long- term outcomes. Although primarily considered a complication during hospitalization, delirium can persist, recur, or initially present during a post-acute stay in a skilled nursing facility. Little is known about delirium care knowledge, confidence, and practices by nurses in post-acute facilities. Measure post-acute care nurses’ knowledge and confidence levels related to delirium prevention, identification and management Describe post-acute care nurses’ documented assessments and actions related to delirious patients. Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. Documentation of nursing assessment and actions were analyzed from records of 22 patients determined to have experienced post-acute delirium using CHART-DEL methodology. Nurses averaged 75% correct on a written delirium knowledge test, with most deficits in identifying the key features of delirium and the assessment of delirium superimposed upon dementia. Most (89%) nurses accurately applied the Confusion Assessment Method Short Form to a video of an individual displaying hypoactive delirium with visual hallucinations, while only 49% did the same with the video depicting hypoactive delirium superimposed on mild cognitive impairment. The majority (85%) of nurses reported lack of confidence in performing delirium screening, specifically surrounding the identification of an acute change in mental status from baseline and the presence of inattention and 56% lacked confidence discussing results of a positive delirium screen with a provider. The term “confusion” was the most documented descriptor in records of patients experiencing delirium with nurses recognizing 40% of verified delirious cases and acting upon 83% of cases they recognized. Nurses working in the post-acute care setting displayed gaps in knowledge, confidence and skills related to delirium prevention, assessment and management.
{"title":"Nurses’ Knowledge, Confidence, Detection and Actions Related to Delirium Care in the Post-Acute Setting","authors":"Christine Waszynski, Jeanne Kessler, Jyoti Chhabra, Thomas Nowicki, Shelby Greco","doi":"10.56392/001c.92213","DOIUrl":"https://doi.org/10.56392/001c.92213","url":null,"abstract":"Delirium is a common and under-recognized condition affecting patients during times of illness or injury and is associated with poor short and long- term outcomes. Although primarily considered a complication during hospitalization, delirium can persist, recur, or initially present during a post-acute stay in a skilled nursing facility. Little is known about delirium care knowledge, confidence, and practices by nurses in post-acute facilities. Measure post-acute care nurses’ knowledge and confidence levels related to delirium prevention, identification and management Describe post-acute care nurses’ documented assessments and actions related to delirious patients. Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. Documentation of nursing assessment and actions were analyzed from records of 22 patients determined to have experienced post-acute delirium using CHART-DEL methodology. Nurses averaged 75% correct on a written delirium knowledge test, with most deficits in identifying the key features of delirium and the assessment of delirium superimposed upon dementia. Most (89%) nurses accurately applied the Confusion Assessment Method Short Form to a video of an individual displaying hypoactive delirium with visual hallucinations, while only 49% did the same with the video depicting hypoactive delirium superimposed on mild cognitive impairment. The majority (85%) of nurses reported lack of confidence in performing delirium screening, specifically surrounding the identification of an acute change in mental status from baseline and the presence of inattention and 56% lacked confidence discussing results of a positive delirium screen with a provider. The term “confusion” was the most documented descriptor in records of patients experiencing delirium with nurses recognizing 40% of verified delirious cases and acting upon 83% of cases they recognized. Nurses working in the post-acute care setting displayed gaps in knowledge, confidence and skills related to delirium prevention, assessment and management.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"43 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139808639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine Waszynski, Jeanne Kessler, Jyoti Chhabra, Thomas Nowicki, Shelby Greco
Delirium is a common and under-recognized condition affecting patients during times of illness or injury and is associated with poor short and long- term outcomes. Although primarily considered a complication during hospitalization, delirium can persist, recur, or initially present during a post-acute stay in a skilled nursing facility. Little is known about delirium care knowledge, confidence, and practices by nurses in post-acute facilities. Measure post-acute care nurses’ knowledge and confidence levels related to delirium prevention, identification and management Describe post-acute care nurses’ documented assessments and actions related to delirious patients. Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. Documentation of nursing assessment and actions were analyzed from records of 22 patients determined to have experienced post-acute delirium using CHART-DEL methodology. Nurses averaged 75% correct on a written delirium knowledge test, with most deficits in identifying the key features of delirium and the assessment of delirium superimposed upon dementia. Most (89%) nurses accurately applied the Confusion Assessment Method Short Form to a video of an individual displaying hypoactive delirium with visual hallucinations, while only 49% did the same with the video depicting hypoactive delirium superimposed on mild cognitive impairment. The majority (85%) of nurses reported lack of confidence in performing delirium screening, specifically surrounding the identification of an acute change in mental status from baseline and the presence of inattention and 56% lacked confidence discussing results of a positive delirium screen with a provider. The term “confusion” was the most documented descriptor in records of patients experiencing delirium with nurses recognizing 40% of verified delirious cases and acting upon 83% of cases they recognized. Nurses working in the post-acute care setting displayed gaps in knowledge, confidence and skills related to delirium prevention, assessment and management.
{"title":"Nurses’ Knowledge, Confidence, Detection and Actions Related to Delirium Care in the Post-Acute Setting","authors":"Christine Waszynski, Jeanne Kessler, Jyoti Chhabra, Thomas Nowicki, Shelby Greco","doi":"10.56392/001c.92213","DOIUrl":"https://doi.org/10.56392/001c.92213","url":null,"abstract":"Delirium is a common and under-recognized condition affecting patients during times of illness or injury and is associated with poor short and long- term outcomes. Although primarily considered a complication during hospitalization, delirium can persist, recur, or initially present during a post-acute stay in a skilled nursing facility. Little is known about delirium care knowledge, confidence, and practices by nurses in post-acute facilities. Measure post-acute care nurses’ knowledge and confidence levels related to delirium prevention, identification and management Describe post-acute care nurses’ documented assessments and actions related to delirious patients. Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. Documentation of nursing assessment and actions were analyzed from records of 22 patients determined to have experienced post-acute delirium using CHART-DEL methodology. Nurses averaged 75% correct on a written delirium knowledge test, with most deficits in identifying the key features of delirium and the assessment of delirium superimposed upon dementia. Most (89%) nurses accurately applied the Confusion Assessment Method Short Form to a video of an individual displaying hypoactive delirium with visual hallucinations, while only 49% did the same with the video depicting hypoactive delirium superimposed on mild cognitive impairment. The majority (85%) of nurses reported lack of confidence in performing delirium screening, specifically surrounding the identification of an acute change in mental status from baseline and the presence of inattention and 56% lacked confidence discussing results of a positive delirium screen with a provider. The term “confusion” was the most documented descriptor in records of patients experiencing delirium with nurses recognizing 40% of verified delirious cases and acting upon 83% of cases they recognized. Nurses working in the post-acute care setting displayed gaps in knowledge, confidence and skills related to delirium prevention, assessment and management.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"65 5-6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139868527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Single Question in Delirium (SQiD) is a widely used delirium detection tool utilising discussion between clinicians and informants. This study aims to understand how the SQiD works in clinical settings. Using qualitative methodology, with a grounded theory framework, informant interviews were analysed to understand better how the SQiD works in clinical contexts. Participants were the adult relatives, carers, or friends (informants) of inpatients in an oncology ward at an acute hospital in Sydney, Australia. The informant was an available person whom staff would ordinarily approach for collateral information. The SQiD was administered and recorded by nursing staff. The recording was transcribed verbatim, checked, and then thematically analysed independently by two researchers. Themes/subthemes were determined and discussed until consensus was reached, then reviewed with a third researcher. Patient demographics, including documented diagnosis of delirium, were extracted from their Electronic Medical Record. Of 29 interviews, 15 patients screened positive for delirium, six of whom had a documented diagnosis of delirium. Emergent themes included recognition of “confusion”, operational factors, and the SQiD outcome. The overarching themes were clinician investment and interest in the process, communication techniques, and knowledge of delirium and other cognitive disorders. This study indicates that the SQiD’s usefulness might be enhanced by providing clinicians with specific education about delirium, and differentiation between delirium and other neurocognitive disorders. Moreover, education could be accompanied by measures to encourage clinicians to extend SQiD discussions, act on SQiD findings, and embed the SQiD in clinical practice through implementation strategies. Clinician investment was inconsistent and warrants further investigation.
{"title":"SQiD talks: A qualitative study about starting conversations with the single question in delirium (SQiD)","authors":"Nandita Hely, Megan B. Sands, Anne P.F. Wand","doi":"10.56392/001c.92217","DOIUrl":"https://doi.org/10.56392/001c.92217","url":null,"abstract":"The Single Question in Delirium (SQiD) is a widely used delirium detection tool utilising discussion between clinicians and informants. This study aims to understand how the SQiD works in clinical settings. Using qualitative methodology, with a grounded theory framework, informant interviews were analysed to understand better how the SQiD works in clinical contexts. Participants were the adult relatives, carers, or friends (informants) of inpatients in an oncology ward at an acute hospital in Sydney, Australia. The informant was an available person whom staff would ordinarily approach for collateral information. The SQiD was administered and recorded by nursing staff. The recording was transcribed verbatim, checked, and then thematically analysed independently by two researchers. Themes/subthemes were determined and discussed until consensus was reached, then reviewed with a third researcher. Patient demographics, including documented diagnosis of delirium, were extracted from their Electronic Medical Record. Of 29 interviews, 15 patients screened positive for delirium, six of whom had a documented diagnosis of delirium. Emergent themes included recognition of “confusion”, operational factors, and the SQiD outcome. The overarching themes were clinician investment and interest in the process, communication techniques, and knowledge of delirium and other cognitive disorders. This study indicates that the SQiD’s usefulness might be enhanced by providing clinicians with specific education about delirium, and differentiation between delirium and other neurocognitive disorders. Moreover, education could be accompanied by measures to encourage clinicians to extend SQiD discussions, act on SQiD findings, and embed the SQiD in clinical practice through implementation strategies. Clinician investment was inconsistent and warrants further investigation.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"22 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139816512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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