Implementing a Rapid, Two-Step Delirium Screening Protocol in Acute Care: Barriers and Facilitators.
delirium
hospitalized older adults
observations
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
14
12
2020
received:
13
11
2020
accepted:
17
12
2020
pubmed:
22
1
2021
medline:
29
9
2021
entrez:
21
1
2021
Statut:
ppublish
Résumé
An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+). A qualitative descriptive design using observational data collection and brief semi-structured interviews. An urban academic medical center and a community teaching hospital. Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs). Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations. The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening. This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
Sections du résumé
BACKGROUND/OBJECTIVES
An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+).
DESIGN
A qualitative descriptive design using observational data collection and brief semi-structured interviews.
SETTINGS
An urban academic medical center and a community teaching hospital.
PARTICIPANTS
Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs).
MEASUREMENTS
Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations.
RESULTS
The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening.
CONCLUSION
This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
Identifiants
pubmed: 33474729
doi: 10.1111/jgs.17026
pmc: PMC8221457
mid: NIHMS1704437
doi:
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1349-1356Subventions
Organisme : NIA NIH HHS
ID : R01 AG044518
Pays : United States
Organisme : NIA NIH HHS
ID : P01AG031720
Pays : United States
Organisme : NIA NIH HHS
ID : R24 AG054259
Pays : United States
Organisme : NIA NIH HHS
ID : K24AG035075
Pays : United States
Organisme : NIA NIH HHS
ID : P01 AG031720
Pays : United States
Organisme : NIA NIH HHS
ID : R01AG030618
Pays : United States
Organisme : NIA NIH HHS
ID : K24 AG035075
Pays : United States
Organisme : NIA NIH HHS
ID : R01AG044518
Pays : United States
Organisme : NINR NIH HHS
ID : R01NR01104
Pays : United States
Organisme : NINR NIH HHS
ID : R01 NR011042
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG030618
Pays : United States
Organisme : NIA NIH HHS
ID : R24AG054259
Pays : United States
Informations de copyright
© 2021 The American Geriatrics Society.
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