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TIME to think about delirium: improving detection and management on the acute medical unit

Delirium affects 18%–35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients a...

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Autores principales: Bauernfreund, Yehudit, Butler, Matthew, Ragavan, Sumathi, Sampson, Elizabeth L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109807/
https://www.ncbi.nlm.nih.gov/pubmed/30167472
http://dx.doi.org/10.1136/bmjoq-2017-000200
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author Bauernfreund, Yehudit
Butler, Matthew
Ragavan, Sumathi
Sampson, Elizabeth L
author_facet Bauernfreund, Yehudit
Butler, Matthew
Ragavan, Sumathi
Sampson, Elizabeth L
author_sort Bauernfreund, Yehudit
collection PubMed
description Delirium affects 18%–35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients and their families. We used quality improvement tools and a multicomponent intervention to promote detection and improve management of delirium on the acute medical unit (AMU). We reviewed whether a delirium screening tool (4AT) had been completed for all patients aged over 65 years admitted to the AMU over 1 week. If delirium was detected, we assessed whether investigation and management was adequate as per national guidance. After baseline data collection, we delivered focused sessions of delirium education for doctors and nursing staff, including training on use of the 4AT tool and the TIME (Triggers, Investigate, Manage, Engage) management bundle. We introduced TIME checklists, an online delirium order set and created a bedside orientation tool. We collected data following the interventions and identified areas for further improvement. Following our first PDSA (Plan, Do, Study, Act) cycle, use of the 4AT screening tool improved from 40% to 61%. Adequate assessment for the causes of and exacerbating factors for delirium increased from 73% to 94% of cases. Use of personal orientation tools improved from 0% to 38%. In summary, a targeted staff education programme and practical aids for the ward have improved the screening and management of delirium on the AMU. This may be improved further through more frequent training sessions to account for regular change-over of junior doctors and through implementing a nursing champion for delirium.
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spelling pubmed-61098072018-08-30 TIME to think about delirium: improving detection and management on the acute medical unit Bauernfreund, Yehudit Butler, Matthew Ragavan, Sumathi Sampson, Elizabeth L BMJ Open Qual BMJ Quality Improvement report Delirium affects 18%–35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients and their families. We used quality improvement tools and a multicomponent intervention to promote detection and improve management of delirium on the acute medical unit (AMU). We reviewed whether a delirium screening tool (4AT) had been completed for all patients aged over 65 years admitted to the AMU over 1 week. If delirium was detected, we assessed whether investigation and management was adequate as per national guidance. After baseline data collection, we delivered focused sessions of delirium education for doctors and nursing staff, including training on use of the 4AT tool and the TIME (Triggers, Investigate, Manage, Engage) management bundle. We introduced TIME checklists, an online delirium order set and created a bedside orientation tool. We collected data following the interventions and identified areas for further improvement. Following our first PDSA (Plan, Do, Study, Act) cycle, use of the 4AT screening tool improved from 40% to 61%. Adequate assessment for the causes of and exacerbating factors for delirium increased from 73% to 94% of cases. Use of personal orientation tools improved from 0% to 38%. In summary, a targeted staff education programme and practical aids for the ward have improved the screening and management of delirium on the AMU. This may be improved further through more frequent training sessions to account for regular change-over of junior doctors and through implementing a nursing champion for delirium. BMJ Publishing Group 2018-08-13 /pmc/articles/PMC6109807/ /pubmed/30167472 http://dx.doi.org/10.1136/bmjoq-2017-000200 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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/.
spellingShingle BMJ Quality Improvement report
Bauernfreund, Yehudit
Butler, Matthew
Ragavan, Sumathi
Sampson, Elizabeth L
TIME to think about delirium: improving detection and management on the acute medical unit
title TIME to think about delirium: improving detection and management on the acute medical unit
title_full TIME to think about delirium: improving detection and management on the acute medical unit
title_fullStr TIME to think about delirium: improving detection and management on the acute medical unit
title_full_unstemmed TIME to think about delirium: improving detection and management on the acute medical unit
title_short TIME to think about delirium: improving detection and management on the acute medical unit
title_sort time to think about delirium: improving detection and management on the acute medical unit
topic BMJ Quality Improvement report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109807/
https://www.ncbi.nlm.nih.gov/pubmed/30167472
http://dx.doi.org/10.1136/bmjoq-2017-000200
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