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Using a multi-component intervention to improve delirium diagnosis and management on surgical wards

By: Contributor(s): Publication details: 2018Uniform titles:
  • Age and Ageing
Online resources: Summary: <span style="font-size: 10pt;">Evidence-base: Delirium occurs frequently in both general surgical and orthopaedic patients. It is often neither detected nor managed appropriately. Delirium increases morbidity and mortality risk, as well as lengthening hospital stay. It is an unpleasant and frightening experience for patients. We used quality improvement tools and a multi-component intervention to improve the detection and management of delirium on the general surgical and orthopaedic wards. Change Strategies: We undertook a snapshot review of all general surgical and orthopaedic inpatients aged over 65 (n = 32). We assessed whether a delirium screening tool (4AT or CAM) had been completed on admission. If delirium was detected, we assessed whether investigation and management was adequate as per NICE & British Geriatric Society guidance, including adequate assessment of possible underlying causes and the use of orientation signage. After baseline data collection, we developed a multi-component intervention. This included targeted delirium education sessions for doctors and nursing staff involving training on use of the 4AT tool and the TIME ("Triggers, Investigations, Management, Engage") bundle, as well as introducing ward-based TIME checklists, an online delirium order set, and a bedside orientation tool. Change Effects: Second collection (n = 24) showed improvement in use of a delirium screening tool from 41% to 63%. Delirium prevalence increased from 31% to 38%. For patients with a diagnosed delirium, adequate assessment for causes and exacerbating factors for delirium increased from 30% to 56% of cases. Use of personal orientation tools improved from 0% to 56%. Conclusion: Following targeted education sessions and multiple ward-based interventions, the surgical wards have improved their screening and management of delirium. The improvements were greater on orthopaedic compared to general surgical wards. We believe further targeted staff education programmes and instituting nursing delirium "champions" for future PDSA cycles will maintain effective delirium management on the surgical wards.&nbsp;</span>
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&lt;span style="font-size: 10pt;"&gt;Evidence-base: Delirium occurs frequently in both general surgical and orthopaedic patients. It is often neither detected nor managed appropriately. Delirium increases morbidity and mortality risk, as well as lengthening hospital stay. It is an unpleasant and frightening experience for patients. We used quality improvement tools and a multi-component intervention to improve the detection and management of delirium on the general surgical and orthopaedic wards. Change Strategies: We undertook a snapshot review of all general surgical and orthopaedic inpatients aged over 65 (n = 32). We assessed whether a delirium screening tool (4AT or CAM) had been completed on admission. If delirium was detected, we assessed whether investigation and management was adequate as per NICE &amp;amp; British Geriatric Society guidance, including adequate assessment of possible underlying causes and the use of orientation signage. After baseline data collection, we developed a multi-component intervention. This included targeted delirium education sessions for doctors and nursing staff involving training on use of the 4AT tool and the TIME ("Triggers, Investigations, Management, Engage") bundle, as well as introducing ward-based TIME checklists, an online delirium order set, and a bedside orientation tool. Change Effects: Second collection (n = 24) showed improvement in use of a delirium screening tool from 41% to 63%. Delirium prevalence increased from 31% to 38%. For patients with a diagnosed delirium, adequate assessment for causes and exacerbating factors for delirium increased from 30% to 56% of cases. Use of personal orientation tools improved from 0% to 56%. Conclusion: Following targeted education sessions and multiple ward-based interventions, the surgical wards have improved their screening and management of delirium. The improvements were greater on orthopaedic compared to general surgical wards. We believe further targeted staff education programmes and instituting nursing delirium "champions" for future PDSA cycles will maintain effective delirium management on the surgical wards.&amp;nbsp;&lt;/span&gt;

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