Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project

BMJ Open Quality

article

Christina Reppas-Rindlisbacher¹  Shailee Siddhpuria²  Eric Kai-Chung Wong¹  Justin Yusen Lee³  Christopher Gabor⁵  Alexandra Curkovic⁵  Yasmin Khalili⁵  Caroline Mavrak⁵  Sandra De Freitas⁵  Kristeen Eshak⁴  Christopher Patterson³ 

[1] Division of Geriatric Medicine , University of Toronto Department of Medicine;Faculty of Medicine , The University of British Columbia;Geriatric Education and Research in Aging Science ,(GERAS) Centre , McMaster University;Division of Geriatric Medicine , McMaster University Department of Medicine;Hamilton Health Sciences;Joseph Brant Memorial Hospital

关键词: nurses;    evidence-based practice;    geriatrics;    healthcare quality improvement;    hip fractures;   

DOI  :  10.1136/bmjoq-2020-001186

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one of the most common postoperative complications in older adults undergoing orthopaedic surgery. Multicomponent, non-pharmacological interventions can reduce delirium incidence by up to 30% but are often challenging to implement as part of routine care. We identified a gap in the delivery of non-pharmacological interventions on an orthopaedic unit. This project aimed to implement a bedside sign on an orthopaedic unit to reduce the occurrence of delirium by prompting staff to use multicomponent evidence-based delirium prevention strategies for at-risk older adults. Quality improvement methods were used to integrate and optimise the use of a bedside ‘delirium prevention’ sign on an orthopaedic unit.The sign was implemented in four target rooms and sign completion rates increased from 47% to 83% (95% CI 71.7% to 94.9%; p<0.001) over a 10-month period. The sign did not have a significant impact on delirium prevalence. The mean Confusion Assessment Method (CAM)+ rate during the baseline period was 8% with an absolute increase in the intervention period to 11.4% (95% CI 7.2% to 15.8%; p=0.31). There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.nursesevidence-based practicegeriatricshealthcare quality improvementhip fractureshttp://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

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