Investigation of ward fidelity to a multicomponent delirium prevention intervention during a multicentre, pragmatic, cluster randomised, controlled feasibility trial.
delirium prevention
intervention fidelity
multi-component intervention
older people
Journal
Age and ageing
ISSN: 1468-2834
Titre abrégé: Age Ageing
Pays: England
ID NLM: 0375655
Informations de publication
Date de publication:
01 07 2020
01 07 2020
Historique:
received:
25
09
2019
pubmed:
21
4
2020
medline:
29
7
2021
entrez:
21
4
2020
Statut:
ppublish
Résumé
delirium is a frequent complication of hospital admission for older people and can be reduced by multicomponent interventions, but implementation and delivery of such interventions is challenging. to investigate fidelity to the prevention of delirium system of care within a multicentre, pragmatic, cluster randomised, controlled feasibility trial. five care of older people and three orthopaedic trauma wards in eight hospitals in England and Wales. research nurse observations of ward practice; case note reviews and examination of documentation. 10 health care professionals with experience in older people's care assessed the fidelity to 21 essential implementation components within four domains: intervention installation (five items; maximum score = 5); intervention delivery (12 items; maximum score = 48); intervention coverage (three items; maximum score = 16); and duration of delivery (one item; maximum score = 1). the mean score (range) for each domain was: installation 4.5 (3.5-5); delivery 32.6 (range 27.3-38.3); coverage 7.9 (range 4.2-10.1); and duration 0.38 (0-1). Of the 10 delirium risk factors, infection, nutrition, hypoxia and pain were the most and cognitive impairment, sensory impairment and multiple medications the least consistently addressed. Overall fidelity to the intervention was assessed as high (≥80%) in two wards, medium (51-79%) in five wards and low (≤50%) in one ward. the trial was designed as a pragmatic evaluation, and the findings of medium intervention fidelity are likely to be generalisable to delirium prevention in routine care and provide an important context to interpret the trial outcomes.
Sections du résumé
BACKGROUND
delirium is a frequent complication of hospital admission for older people and can be reduced by multicomponent interventions, but implementation and delivery of such interventions is challenging.
OBJECTIVE
to investigate fidelity to the prevention of delirium system of care within a multicentre, pragmatic, cluster randomised, controlled feasibility trial.
SETTING
five care of older people and three orthopaedic trauma wards in eight hospitals in England and Wales.
DATA COLLECTION
research nurse observations of ward practice; case note reviews and examination of documentation.
ASSESSMENT
10 health care professionals with experience in older people's care assessed the fidelity to 21 essential implementation components within four domains: intervention installation (five items; maximum score = 5); intervention delivery (12 items; maximum score = 48); intervention coverage (three items; maximum score = 16); and duration of delivery (one item; maximum score = 1).
RESULTS
the mean score (range) for each domain was: installation 4.5 (3.5-5); delivery 32.6 (range 27.3-38.3); coverage 7.9 (range 4.2-10.1); and duration 0.38 (0-1). Of the 10 delirium risk factors, infection, nutrition, hypoxia and pain were the most and cognitive impairment, sensory impairment and multiple medications the least consistently addressed. Overall fidelity to the intervention was assessed as high (≥80%) in two wards, medium (51-79%) in five wards and low (≤50%) in one ward.
CONCLUSION
the trial was designed as a pragmatic evaluation, and the findings of medium intervention fidelity are likely to be generalisable to delirium prevention in routine care and provide an important context to interpret the trial outcomes.
Identifiants
pubmed: 32310260
pii: 5821445
doi: 10.1093/ageing/afaa042
pmc: PMC7331099
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
648-655Subventions
Organisme : Department of Health
ID : PB-PG-0610-22068
Pays : United Kingdom
Organisme : Department of Health
ID : RP-PG-0108-10037
Pays : United Kingdom
Organisme : NIA NIH HHS
ID : R24 AG054259
Pays : United States
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society.
Références
Arch Intern Med. 2003 Apr 28;163(8):958-64
pubmed: 12719206
Age Ageing. 2013 Nov;42(6):721-7
pubmed: 23978407
Implement Sci. 2007 Nov 30;2:40
pubmed: 18053122
BMC Health Serv Res. 2013 Sep 03;13:341
pubmed: 24004917
Age Ageing. 2015 Mar;44(2):196-204
pubmed: 25424450
J Am Geriatr Soc. 2009 Nov;57(11):2029-36
pubmed: 19754498
Adm Policy Ment Health. 2011 Mar;38(2):65-76
pubmed: 20957426
Lancet. 2014 Mar 8;383(9920):911-22
pubmed: 23992774
Age Ageing. 2020 Jul 1;49(4):640-647
pubmed: 32307515
Implement Sci. 2012 Mar 22;7:23
pubmed: 22436121
J Am Geriatr Soc. 2000 Dec;48(12):1697-706
pubmed: 11129764
N Engl J Med. 1999 Mar 4;340(9):669-76
pubmed: 10053175
BMC Geriatr. 2019 Dec 31;20(1):1
pubmed: 31892317
Am J Community Psychol. 2008 Jun;41(3-4):327-50
pubmed: 18322790
Cochrane Database Syst Rev. 2016 Mar 11;3:CD005563
pubmed: 26967259
J Am Geriatr Soc. 2001 May;49(5):516-22
pubmed: 11380742
J Public Health Dent. 2011 Winter;71(s1):S52-S63
pubmed: 21499543
Milbank Q. 2004;82(4):581-629
pubmed: 15595944
J Am Geriatr Soc. 2011 Jul;59(7):1299-308
pubmed: 21718273
Trials. 2015 Aug 08;16:340
pubmed: 26253332
J Clin Nurs. 2010 Jun;19(11-12):1544-52
pubmed: 20438599
J Eval Clin Pract. 2014 Aug;20(4):445-52
pubmed: 24840165
BMJ Open. 2013 Jan 07;3(1):
pubmed: 23299110
Health Psychol. 2004 Sep;23(5):443-51
pubmed: 15367063