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Soboh R, Gino-Moor S, Jiris N, Ginsberg S, Oliven R. Validation of a viable delirium detection test performed by nurses and physicians during routine patient care. BMC Geriatr 2024; 24:297. [PMID: 38549098 PMCID: PMC10976736 DOI: 10.1186/s12877-024-04884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Delirium is a frequent mental impairment in geriatric patients hospitalized in acute care facilities. It carries a high risk of complications and is often the first symptom of acute illness. It is clearly important to identify the development of delirium at an early stage, and several short and effective diagnostic tests have been developed and validated for this purpose. Despite this, patients on hospital wards are seldom monitored for signs of emergent delirium, suggesting that compliance with guidelines would be improved by introducing a simpler and more user-friendly test. METHODS We recently implemented a simple delirium assessment tool, called RMA that can be introduced into the daily routine of ward staff without significantly adding to their workload. The nurses noted their impression of the patient's cognitive state in the electronic medical record, and during the morning round the ward physician administered a short attention test to any patients suspected of new cognitive impairment. In this study, we compared RMA test against the widely used and well validated 4AT. RESULTS RMA performed daily by the ward staff was found to be non-inferior to 4AT performed by an experienced rater. Compared to 4AT, R&M had a sensitivity of 93.9% and a specificity of 98.3%. An Altman-Bland plot indicated that both tests can be used interchangeably. CONCLUSIONS The RMA test is reliable, easy to administer, likely to boost compliance with guidelines, and is expected to raise awareness of delirium among the nurses and physicians directly involved in the diagnostic process.
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Affiliation(s)
| | - Sharon Gino-Moor
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel
| | - Nizar Jiris
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel
| | - Shira Ginsberg
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel
| | - Ron Oliven
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel.
- Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel.
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Thielen JR, Sawyer JE, Henry BM, Zebracki J, Cooper DS, Koh W. Short-Term Effect of Quetiapine Used to Treat Delirium Symptoms on Opioid and Benzodiazepine Requirements in the Pediatric Cardiac Intensive Care Unit. Pediatr Cardiol 2024; 45:666-672. [PMID: 35933475 DOI: 10.1007/s00246-022-02980-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
Opioids or benzodiazepines use is known to increase the risk of delirium. The prevalence of delirium is high in pediatric cardiac intensive care units (CICUs) with associated morbidity and mortality. We investigate the short-term effects of quetiapine, an atypical antipsychotic medication, on opioid and benzodiazepine requirements, and any associated adverse events as we utilize quetiapine to treat delirium symptoms in this single-center, retrospective study. Twenty-eight patients who received quetiapine between January 2018 and June 2019 in the CICU met inclusion criteria for the analysis. The quetiapine initiation dose was 0.5 mg/kg/dose every 8 h and we allowed 48 h for quetiapine to reach a steady state. Overall opioid and benzodiazepine requirements were compared 72 h before and 72 h after the quetiapine steady state. There was a statistically significant reduction in the total daily opioid (p = 0.001) and benzodiazepine (p = 0.01) amounts following quetiapine initiation. There was also a statistically significant decrease in the total number of daily PRNs requirement for both opioids (p < 0.001) and benzodiazepines (p = 0.03). Nine out of 13 patients were completely weaned off continuous opioid drips following quetiapine initiation (p = 0.01). The presence of steady-state habituation medications, including methadone or lorazepam, did not have any statistically significant effect on weaning continuous opioid (p = 0.18) or benzodiazepine (p = 0.62) drips. There was no statistically significant effect of quetiapine on the QTc interval after quetiapine initiation (p = 0.58) with no clinically significant arrhythmias observed during the study period. Our study demonstrates a statistically significant reduction in opioid and benzodiazepine requirements following quetiapine initiation to treat delirium symptoms without significant adverse effects in patients with congenital heart disease in the short term.
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Affiliation(s)
- Jessica R Thielen
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2003, Cincinnati, OH, 45229, USA
| | - Jaclyn E Sawyer
- Division of Pharmacy, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brandon M Henry
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2003, Cincinnati, OH, 45229, USA
| | - Jessica Zebracki
- Division of Pharmacy, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2003, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Wonshill Koh
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2003, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Titlestad I, Haugarvoll K, Solvang SEH, Norekvål TM, Skogseth RE, Andreassen OA, Årsland D, Neerland BE, Nordrehaug JE, Tell GS, Giil LM. Delirium is frequently underdiagnosed among older hospitalised patients despite available information in hospital medical records. Age Ageing 2024; 53:afae006. [PMID: 38342753 PMCID: PMC10859244 DOI: 10.1093/ageing/afae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND In-hospital delirium is associated with adverse outcomes and is underdiagnosed, limiting research and clinical follow-up. OBJECTIVE To compare the incidence of in-hospital delirium determined by chart-based review of electronic medical records (D-CBR) with delirium discharge diagnoses (D-DD). Furthermore, to identify differences in symptoms, treatments and delirium triggers between D-CBR and D-DD. METHOD The community-based cohort included 2,115 participants in the Hordaland Health Study born between 1925 and 1927. Between 2018 and 2022, we retrospectively reviewed hospital electronic medical records from baseline (1997-99) until death prior to 2023. D-DD and D-CBR were validated using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for delirium. RESULTS Of the 2,115 participants, 638 had in-hospital delirium. The incidence rate (IR) of D-CBR was 29.8 [95% confidence interval 28, 32] per 1,000 person-years, whereas the IR by D-DD was 3.4 [2.8, 4.2]. The IR ratio was 9.14 (P < 0.001). Patients who received pharmacological treatment for delirium (n = 121, odds ratio (OR) 3.4, [2.1, 5.4], P < 0.001), who were affected by acute memory impairment (n = 149, OR 2.8, [1.8, 4.5], P < 0.001), or change in perception (n = 137, OR 2.9, [1.8, 4.6] P < 0.001) had higher odds for D-DD. In contrast, post-operative cases (OR 0.2, [0.1, 0.4], P < 0.001) had lower odds for D-DD. CONCLUSION Underdiagnosis of in-hospital delirium was a major issue in our study, especially in less severe delirium cases. Our findings emphasise the need for integrating systematic delirium diagnostics and documentation into hospital admission and discharge routines.
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Affiliation(s)
- Irit Titlestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Kristoffer Haugarvoll
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stein-Erik H Solvang
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ragnhild E Skogseth
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Årsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bjørn Erik Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lasse M Giil
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Xiong B, Bailey DX, Prudon P, Pascoe EM, Gray LC, Graham F, Henderson A, Martin-Khan M. Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review. Int J Nurs Sci 2024; 11:120-132. [PMID: 38352291 PMCID: PMC10859579 DOI: 10.1016/j.ijnss.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Recognition of the cognitive status of patients is important so that care can be tailored accordingly. The objective of this integrative review was to report on the current practices that acute care hospitals use to identify people with cognitive impairment and how information about cognition is managed within the healthcare record as well as the approaches required and recommended by policies. Methods Following Whittemore & Knafl's five-step method, we systematically searched Medline, CINAHL, and Scopus databases and various grey literature sources. Articles relevant to the programs that have been implemented in acute care hospitals regarding the identification of cognitive impairment and management of cognition information were included. The Mixed Methods Appraisal Tool and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) Checklist were used to evaluate the quality of the studies. Thematic analysis was used to present and synthesise results. This review was pre-registered on PROSPERO ( CRD42022343577). Results Twenty-two primary studies and ten government/industry publications were included in the analysis. Findings included gaps between practice and policy. Although identification of cognitive impairment, transparency of cognition information, and interaction with patients, families, and carers (if appropriate) about this condition were highly valued at a policy level, sometimes in practice, cognitive assessments were informal, patient cognition information was not recorded, and interactions with patients, families, and carers were lacking. Discussion By incorporating cognitive assessment, developing an integrated information management system using information technology, establishing relevant laws and regulations, providing education and training, and adopting a national approach, significant improvements can be made in the care provided to individuals with cognitive impairment.
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Affiliation(s)
- Beibei Xiong
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel X. Bailey
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women’s Hospital, Brisbane, Australia
| | - Paul Prudon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Frederick Graham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Dementia and Delirium, Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Amanda Henderson
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Australia
- Griffith Health, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Brisbane, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- School of Nursing, University of Northern British Columbia, Prince George, Canada
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O'Brien A, Hopkins J, Boardman G, Stanley G, Daly P, Martin L, Wood F. A retrospective, cross-sectional analysis of delirium in burn injury compared to other surgical specialities. Burns 2023; 49:1676-1687. [PMID: 37821275 DOI: 10.1016/j.burns.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Delirium is an acute cerebral disorder characterised by a disturbance in cognition, attention, and awareness. Often, it's undiagnosed and associated with increased morbidity and mortality. For burn patients, the reported prevalence ranges from 16% to 39%, with a multifactorial aetiology, increasing when intensive care is required. A direct comparison of delirium between surgical specialities has not been made. AIM 1. To audit the use of the 4AT for those who become delirious during their stay. 2. Assess the proportion of patients diagnosed with delirium during hospitalisation by surgical specialities. 3. Identification of the factors associated with delirium in surgical patients. METHODS Investigators at a single centre conducted a two-phase study. An initial retrospective audit of delirious patients under burns, general, and orthopaedic specialities over 16months, as defined by ICD-10 coding, identified compliance screening with the 4 A's Test. This informed the design of a retrospective, observational cohort study to compare factors associated with delirium and statistical comparison between four specialities to identify delirium-associated factor, where an analysis corrects for age. RESULTS 37% of patients with an ICD-10 code indicating delirium had a 4AT test completed. Speciality, number of operations, LOS, ICU hours, age, and discharge destination were all statistically significant independent variables. When all other variables were equal, burns had the highest predicted probability of delirium diagnosis. CONCLUSIONS Further analysis to identify and diagnose across the specialties is required. From a patient viewpoint, their LOS, ICU hours, and operations are increased for patients coded as delirious compared to non-delirious across the specialities. On a hospital level, the mean difference in cost for a delirious compared to a non-delirious patient is AU$9317. Despite the low incidence of delirium amongst the observed specialities, burns patients were most likely to develop delirium when demographic and clinical profiles were the same, and were more likely to develop delirium at a younger age and if in ICU.
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Affiliation(s)
- Aoife O'Brien
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia.
| | - Jane Hopkins
- Service 4, Fiona Stanley Fremantle Hospitals Group, Western Australia, Australia
| | - Glenn Boardman
- Research Support and Development Unit, Fiona Stanley Hospital, Western Australia, Australia
| | - Guy Stanley
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
| | - Patrick Daly
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia
| | - Lisa Martin
- Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
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Blättler N, Schaffert B, Schubert M. [Evaluation of the implementation of non-pharmacological measures for the prevention and treatment of delirium: A retrospective cohort study]. Pflege 2023. [PMID: 36749189 DOI: 10.1024/1012-5302/a000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Evaluation of the implementation of non-pharmacological measures for the prevention and treatment of delirium: A retrospective cohort study Abstract. Background: Delirium is burdensome for the affected patients, their relatives, hospital staff and the health care system. Preventing delirium with targeted multicomponent interventions is therefore essential. Aim: To investigate the implementation of defined non-pharmacological, preventive, and supportive measures in patients with an increased risk of delirium and/or delirium by the hospital's directions. Methods: In this observational study, routine data from 175 hospitalized patients were included. Data on delirium prevention, treatment and presence of delirium were extracted from the patient records and analyzed using appropriate statistical methods. Group comparisons were made between the medical/surgical clinic and the delirium/no delirium group. Results: Of the 175 patients, 31 had delirium. For delirium prevention, measures to improve oxygen supply, excretion, pain and mobility were most frequently implemented and measures such as improving cognition and communication were least frequently implemented. In the case of delirium, measures to modify risk factors, ensure safety, as well as prophylaxis were applied most frequently. Between the two clinics and between the delirium/no delirium group significant differences in the frequency of these measures were shown. Conclusion: The differences in frequency of implementation provide preliminary evidence that clinic-specific delirium prevention, early detection, and treatment may be needed.
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Affiliation(s)
- Nadia Blättler
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| | - Bianca Schaffert
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| | - Maria Schubert
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
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Proposing a Scientific and Technological Approach to the Summaries of Clinical Issues of Inpatient Elderly with Delirium: A Viewpoint. Healthcare (Basel) 2022; 10:healthcare10081534. [PMID: 36011191 PMCID: PMC9408148 DOI: 10.3390/healthcare10081534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background/rationale: Despite mounting evidence about delirium, this complex geriatric syndrome is still not well managed in clinical contexts. The aging population creates a very demanding area for innovation and technology in healthcare. For instance, an outline of an aging-friendly healthcare environment and clear guidance for technology-supported improvements for people at delirium risk are lacking. Objective: We aimed to foster debate about the importance of technical support in optimizing healthcare professional practice and improving the outcomes for inpatients’ at delirium risk. We focused on critical clinical points in the field of delirium worthy of being addressed by a multidisciplinary approach. Methods: Starting from a consensus workshop sponsored by the Management Perfectioning Course based at the Marco Biagi Foundation (Modena, Italy) about clinical issues related to delirium management still not addressed in our healthcare organizations, we developed a requirements’ analysis among the representatives of different disciplines and tried to formulate how technology could support the summaries of the clinical issues. We analyzed the national and international panorama by a PubMed consultation of articles with the following keywords in advanced research: “delirium”, “delirium management”, “technology in healthcare”, and “elderly population”. Results: Despite international recommendations, delirium remains underdiagnosed, underdetected, underreported, and mismanaged in the acute hospital, increasing healthcare costs, healthcare professionals’ job distress, and poor clinical outcomes. Discussion: Although all healthcare professionals recognize delirium as a severe and potentially preventable source of morbidity and mortality for hospitalized older people, it receives insufficient attention in resource allocation and multidisciplinary research. We synthesized how tech-based tools could offer potential solutions to the critical clinical points in delirium management.
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Chuen VL, Chan ACH, Ma J, Alibhai SMH, Chau V. Assessing the Accuracy of International Classification of Diseases (ICD) Coding for Delirium. J Appl Gerontol 2022; 41:1485-1490. [PMID: 35176883 PMCID: PMC9024024 DOI: 10.1177/07334648211067526] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We assessed the accuracy of the ICD-10 code for delirium (F05) and its relationship with delirium discharge summary documentation. METHODS We performed a retrospective chart review at three academic hospitals. The Chart-based Delirium Identification Instrument (CHART-DEL) was used to identify 108 hospitalized patients aged ≥65 years with delirium, and 758 patients without delirium as controls. We assessed the proportion of patients who received the F05 code and calculated the sensitivity and specificity. We compared the rates of F05 code received between patients with and without "delirium" documented in the discharge summary. RESULTS Among delirious patients, 46.3% received a F05 code, which has a sensitivity of 46.3% and specificity of 99.6% for delirium. Of charts with "delirium" in the discharge summary (n = 67), 67.2% were appropriately coded. CONCLUSIONS Current ICD-10 data inadequately capture delirium. Delirium documentation in the discharge summary is associated with improved delirium coding.
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Affiliation(s)
- Victoria L Chuen
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, 3710McMaster University, Hamilton, ON, Canada
| | - Adrian C H Chan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jin Ma
- Biostatistics Research Unit, 7989University Health Network, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Division of General Internal Medicine and Geriatrics, Department of Medicine, 7989University Health Network, Toronto, ON, Canada.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Vicky Chau
- Division of General Internal Medicine and Geriatrics, Department of Medicine, 7989University Health Network, Toronto, ON, Canada.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Sinai Health System, Toronto, ON, Canada
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Eagles D, Cheung WJ, Avlijas T, Yadav K, Ohle R, Taljaard M, Molnar F, Stiell IG. Barriers and facilitators to nursing delirium screening in older emergency patients: a qualitative study using the theoretical domains framework. Age Ageing 2022; 51:6509750. [PMID: 35061872 DOI: 10.1093/ageing/afab256] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND delirium is common in older emergency department (ED) patients, but vastly under-recognised, in part due to lack of standardised screening processes. Understanding local context and barriers to delirium screening are integral for successful implementation of a delirium screening protocol. OBJECTIVES we sought to identify barriers and facilitators to delirium screening by nurses in older ED patients. METHODS we conducted 15 semi-structured, face-to-face interviews based on the Theoretical Domains Framework with bedside nurses, nurse educators and managers at two academic EDs in 2017. Two research assistants independently coded transcripts. Relevant domains and themes were identified. RESULTS a total of 717 utterances were coded into 14 domains. Three dominant themes emerged: (i) lack of clinical prioritisation because of competing demands, lack of time and heavy workload; (ii) discordance between perceived capabilities and knowledge and (iii) hospital culture. CONCLUSION this qualitative study explored nursing barriers and facilitators to delirium screening in older ED patients. We found that delirium was recognised as an important clinical problem; however, it was not clinically prioritised; there was a false self-perception of knowledge and ability to recognise delirium and hospital culture was a strong influencer of behaviour. Successful adoption of a delirium screening protocol will only be realised if these issues are addressed.
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Affiliation(s)
- Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Tanja Avlijas
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Ohle
- Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frank Molnar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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