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Fox A, Dulhunty J, Ballard E, Fraser M, Macandrew M, Taranec S, Waters R, Yang M, Yates M, Yelland C, Beattie E. The impact of a cognitive impairment support program on patients in an acute care setting: a pre-test post-test intervention study. BMC Geriatr 2023; 23:260. [PMID: 37127621 PMCID: PMC10150670 DOI: 10.1186/s12877-023-03930-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/24/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Patients with cognitive impairment are at greater risk of hospital acquired complications, longer hospital stays, and poor health outcomes compared to patients without cognitive impairment. The Cognitive Impairment Support Program is a multi-disciplinary approach to improve screening rates and awareness of patients with cognitive impairment and guide clinician response and communication during their hospitalisation to improve health outcomes. OBJECTIVE This study evaluated the impact of implementing the Cognitive Impairment Support Program on patient hospital acquired complications, patient reported quality of life and staff satisfaction in an outer metropolitan hospital. DESIGN A pre-test post-test design was used to collect data in two 6-month time periods between March 2020 and November 2021. PARTICIPANTS Patients aged ≥ 65 years, admitted to a participating ward for > 24 h. INTERVENTION The Cognitive Impairment Support Program consisted of four components: cognitive impairment screening, initiation of a Cognitive Impairment Care Plan, use of a Cognitive Impairment Identifier and associated staff education. MEASURES The primary outcome was hospital acquired complications experienced by patients with cognitive impairment identified using clinical coding data. Secondary outcomes were patient quality of life and a staff confidence and perceived organisational support to care for patients with cognitive impairment. RESULTS Hospital acquired complication rates did not vary significantly between the two data collection periods for patients experiencing cognitive impairment with a 0.2% (95% confidence interval: -5.7-6.1%) reduction in admissions with at least one hospital acquired complication. Patients in the post intervention period demonstrated statistically significant improvements in many items in two of the Dementia Quality of Life Measure domains: memory and everyday life. The staff survey indicated statistically significant improvement in clinical staff confidence to care for patients with cognitive impairment (p = 0.003), satisfaction with organisational support for patients (p = 0.004) and job satisfaction (p ≤ 0.001). CONCLUSION This study provides evidence that a multicomponent Cognitive Impairment Support Program had a positive impact on staff confidence and satisfaction and patient quality of life. Broader implementation with further evaluation of the multicomponent cognitive impairment intervention across a range of settings using varied patient outcomes is recommended.
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Affiliation(s)
- Amanda Fox
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia.
- School of Nursing, Faculty of Health, Queensland University of Technology, N Block, Victoria Park Road, Kelvin Grove, Brisbane, QLD, Australia.
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Australia.
| | - Joel Dulhunty
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Maria Fraser
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Australia
| | - Margaret Macandrew
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, N Block, Victoria Park Road, Kelvin Grove, Brisbane, QLD, Australia
| | - Sally Taranec
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Australia
| | | | - Min Yang
- School of Nursing, Faculty of Health, Queensland University of Technology, N Block, Victoria Park Road, Kelvin Grove, Brisbane, QLD, Australia
| | - Mark Yates
- Ballarat Health Services, Ballarat, Australia
| | | | - Elizabeth Beattie
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, N Block, Victoria Park Road, Kelvin Grove, Brisbane, QLD, Australia
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Kakiuchi S, Burger K, Lo SHY. Improving Delirium Care in Hospitalized Older Adults: Impact of Education on Hospital Aides as Sitters. J Gerontol Nurs 2021; 47:20-26. [PMID: 34044684 DOI: 10.3928/00989134-20210507-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As one of several hospital team members involved in the management of care for older adults with delirium, hospital aides (HAs) are often relied on to provide direct patient care in the role of a sitter. Yet, many HAs have not received training about delirium, its associated behaviors, or appropriate interventions. As a consequence, there are gaps in quality of care for older adults with delirium and potential missed opportunities for HA sitters to contribute to the interdisciplinary team (IDT) care of these patients. In the current study, a quality improvement project at an urban hospital provided an educational session on delirium to HAs. Accuracy of HA delirium knowledge, delirium behavior recognition, and delivery of care to patients with delirium significantly increased across three postintervention measures (p = <0.001 to 0.016). HAs also reported increased confidence in caring for patients with delirium and in their perceived role on the IDT. [Journal of Gerontological Nursing, 47(6), 20-26.].
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Toward prevention of behavioral emergencies in a general hospital insights from a one-year series. Gen Hosp Psychiatry 2020; 66:54-58. [PMID: 32688093 DOI: 10.1016/j.genhosppsych.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/06/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Behavioral emergencies endanger hospital staff and patients. The objective of this study was to identify patient characteristics that could be used to predict and prevent these incidents. METHODS We analyzed a one-year consecutive series of behavioral emergencies that triggered the rapid response team at a general hospital, comparing study patients with controls who did not trigger a rapid response. Standard parametric or nonparametric tests, as appropriate, were used to compare the 2 groups in univariate analyses, and multivariable logistic regression analysis was used to identify the best combination of variables for stratifying the risk of such an event. RESULTS There were 109 behavioral emergencies involving 83 patients. Comparison of patients who did (n = 83) or did not (n = 22,849) trigger a rapid response revealed marked differences between the two groups with respect to age, sex, and the prevalence of psychiatric comorbidities and various conditions that can diminish cognitive function. Substance use disorder was the most frequent principal diagnosis in the study group, accounting for 10.8% (9/83) of study patients vs. 0.6% (132/22849) of controls (p < 0.0001). The presence of a condition that can impair cognition (substance intoxication and withdrawal, epilepsy, cerebrovascular disease, traumatic brain injury, delirium, dementia) was associated with a 13-fold increase in the risk of a behavioral disturbance (95% CI, 8 to 22-fold). CONCLUSIONS Brief cognitive assessment of patients susceptible to cognitive impairment, along with diligent prophylaxis and management of substance withdrawal and delirium, may facilitate prevention of behavioral emergencies.
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