'The prevention of delirium in the acute care setting'

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'The prevention of delirium in the acute care setting'

Postby S.E. Humphries » Fri May 08, 2009 12:09 pm

Research Institute for Life Course Studies

Seminar

Wednesday 24th June 2009 2pm
Claus Moser Research Centre – Room CM0.12A

“The prevention of delirium in the acute care setting –
an action research project”

Professor Isabel Higgins
Professor of Older Person Nursing
School of Nursing and Midwifery, Faculty of Health
The University of Newcastle, Hunter New England Health, Australia


Abstract:
Delirium is characterised by a disturbance of consciousness and a change in cognition that develops over a short period of time. It affects up to 56% of older people admitted to hospital. Between 60 and 80 per cent of hospitalized older people experience at least one episode of delirium. Delirium is often under recognised, misdiagnosed, and mistreated. Delirium can be prevented during hospitalization with judicious assessment of risk factors. The gold standard for delirium care is its prevention which reduces its frequency, complications and adverse events of acute hospitalization such as death, falls, and pressure areas. To date, there are many best practice guidelines for delirium in older people published internationally. The aim of this paper is to discuss the findings of a practice redesign project and its impact 12 months following implementation.

Using a Participatory Action Research approach weekly group meetings with 8 clinicians were held over six months. Data analysis included group meeting data, debrief meeting data, chart audit and ward data analysis. Evaluation of the outcomes of the action research project included survey questionnaire, chart audit and focus group interview.

A protocol for delirium prevention was designed and implemented by clinicians. One year following implementation the protocol was used by up to 80% of the staff and there was evidence of practice change.

This study demonstrates the potential for PAR as a process to engage health care practitioners in changed practice. The use of intervention protocols for delirium risk factors significantly reduces the number and duration of episodes of delirium and is considered the “gold standard” for delirium care. What we have shown in this study is that the process used to adapt and implement evidence based guidelines may address the gap between the uptake of guidelines and actual clinical care.
S.E. Humphries
 
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