Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care
Background: Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management. Aim: To inform a future...
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| Veröffentlicht in: | Palliative medicine 2024-04, Vol.38 (4), p.447-456 |
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| creator | Jackson, Gillian P Jackson, Catriona E Boland, Jason W Featherstone, Imogen Huang, Chao Ogden, Margaret Sartain, Kathryn Siddiqi, Najma Twiddy, Maureen Pearson, Mark Johnson, Miriam J |
| description | Background:
Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management.
Aim:
To inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium).
Design:
With Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible.
Setting/participants:
In-patient admissions in three English hospices.
Results:
Between June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%–28%; delirium risk assessment 0%–16%; screening on admission 7%–35%.
Conclusions:
Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study. |
| doi_str_mv | 10.1177/02692163241236325 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11025298</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_02692163241236325</sage_id><sourcerecordid>3040268035</sourcerecordid><originalsourceid>FETCH-LOGICAL-p354t-a322eee9c771f446572040d5bad02c3724ec123f44e356b43e0f0b4d1653d1863</originalsourceid><addsrcrecordid>eNplks1u1DAQxy0EokvhAbhZ4lKkpvgryS4XtOoHrdSKHkDiFjnxJOvKsYPtrNiH5V1q7xYh4OSx5zf_Gc8MQm8pOaO0rj8QVq0YrTgTlPF0lM_Qgoq6Lggn35-jRfYXGThCr0J4IIRyUomX6IgvKy4Ypwv062acvNtqO-C4AXwBEbqonT3F6xAghBFsPMV30soBso2lVfjewzbZCcOuTzFGez2PWFt87cKkOwj4ZK-2vrsHW1zgEGe1e_8RX4EMutVGx93hLcdL3Bv4qVsDe_HQSSPzRY-T2eeU-0whehlh2OHosEopt-DxMOtsWiik2oDP9anf1XTSw2v0opcmwJun8xh9u7r8en5d3H75fHO-vi0mXopYSM4YAKy6uqa9EFVZMyKIKlupCOt4zQR0qcPJBbysWsGB9KQVilYlVzT18hh9OuhOczuC6lIhXppm8nqUftc4qZu_PVZvmsFtG0oJK9lqmRROnhS8-zFDiM2oQwfGSAtuDg0necZ0xUVC3_2DPrjZ2_S_TKWZLwkvE3V2oEKa3B-CkiavTvPf6vBHynS4hw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3040268035</pqid></control><display><type>article</type><title>Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>SAGE Complete</source><creator>Jackson, Gillian P ; Jackson, Catriona E ; Boland, Jason W ; Featherstone, Imogen ; Huang, Chao ; Ogden, Margaret ; Sartain, Kathryn ; Siddiqi, Najma ; Twiddy, Maureen ; Pearson, Mark ; Johnson, Miriam J</creator><creatorcontrib>Jackson, Gillian P ; Jackson, Catriona E ; Boland, Jason W ; Featherstone, Imogen ; Huang, Chao ; Ogden, Margaret ; Sartain, Kathryn ; Siddiqi, Najma ; Twiddy, Maureen ; Pearson, Mark ; Johnson, Miriam J</creatorcontrib><description>Background:
Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management.
Aim:
To inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium).
Design:
With Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible.
Setting/participants:
In-patient admissions in three English hospices.
Results:
Between June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%–28%; delirium risk assessment 0%–16%; screening on admission 7%–35%.
Conclusions:
Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study.</description><identifier>ISSN: 0269-2163</identifier><identifier>EISSN: 1477-030X</identifier><identifier>DOI: 10.1177/02692163241236325</identifier><identifier>PMID: 38634231</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adherents ; Clinical assessment ; Clinical outcomes ; COVID-19 ; Data collection ; Delirium ; Evaluation ; Feasibility ; Feasibility studies ; Hospices ; Implementation ; Inpatient care ; Intervention ; Medical diagnosis ; Medical screening ; Original ; Palliative care ; Patient admissions ; Patient participation ; Patients ; Risk assessment</subject><ispartof>Palliative medicine, 2024-04, Vol.38 (4), p.447-456</ispartof><rights>The Author(s) 2024</rights><rights>The Author(s) 2024 2024 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-9042-7600 ; 0000-0001-7628-7421 ; 0000-0001-6204-9158 ; 0000-0001-5272-3057 ; 0000-0001-5690-4920</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/02692163241236325$$EPDF$$P50$$Gsage$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/02692163241236325$$EHTML$$P50$$Gsage$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,21798,27901,27902,30976,43597,43598</link.rule.ids></links><search><creatorcontrib>Jackson, Gillian P</creatorcontrib><creatorcontrib>Jackson, Catriona E</creatorcontrib><creatorcontrib>Boland, Jason W</creatorcontrib><creatorcontrib>Featherstone, Imogen</creatorcontrib><creatorcontrib>Huang, Chao</creatorcontrib><creatorcontrib>Ogden, Margaret</creatorcontrib><creatorcontrib>Sartain, Kathryn</creatorcontrib><creatorcontrib>Siddiqi, Najma</creatorcontrib><creatorcontrib>Twiddy, Maureen</creatorcontrib><creatorcontrib>Pearson, Mark</creatorcontrib><creatorcontrib>Johnson, Miriam J</creatorcontrib><title>Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care</title><title>Palliative medicine</title><addtitle>Palliat Med</addtitle><description>Background:
Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management.
Aim:
To inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium).
Design:
With Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible.
Setting/participants:
In-patient admissions in three English hospices.
Results:
Between June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%–28%; delirium risk assessment 0%–16%; screening on admission 7%–35%.
Conclusions:
Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study.</description><subject>Adherents</subject><subject>Clinical assessment</subject><subject>Clinical outcomes</subject><subject>COVID-19</subject><subject>Data collection</subject><subject>Delirium</subject><subject>Evaluation</subject><subject>Feasibility</subject><subject>Feasibility studies</subject><subject>Hospices</subject><subject>Implementation</subject><subject>Inpatient care</subject><subject>Intervention</subject><subject>Medical diagnosis</subject><subject>Medical screening</subject><subject>Original</subject><subject>Palliative care</subject><subject>Patient admissions</subject><subject>Patient participation</subject><subject>Patients</subject><subject>Risk assessment</subject><issn>0269-2163</issn><issn>1477-030X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>7QJ</sourceid><recordid>eNplks1u1DAQxy0EokvhAbhZ4lKkpvgryS4XtOoHrdSKHkDiFjnxJOvKsYPtrNiH5V1q7xYh4OSx5zf_Gc8MQm8pOaO0rj8QVq0YrTgTlPF0lM_Qgoq6Lggn35-jRfYXGThCr0J4IIRyUomX6IgvKy4Ypwv062acvNtqO-C4AXwBEbqonT3F6xAghBFsPMV30soBso2lVfjewzbZCcOuTzFGez2PWFt87cKkOwj4ZK-2vrsHW1zgEGe1e_8RX4EMutVGx93hLcdL3Bv4qVsDe_HQSSPzRY-T2eeU-0whehlh2OHosEopt-DxMOtsWiik2oDP9anf1XTSw2v0opcmwJun8xh9u7r8en5d3H75fHO-vi0mXopYSM4YAKy6uqa9EFVZMyKIKlupCOt4zQR0qcPJBbysWsGB9KQVilYlVzT18hh9OuhOczuC6lIhXppm8nqUftc4qZu_PVZvmsFtG0oJK9lqmRROnhS8-zFDiM2oQwfGSAtuDg0necZ0xUVC3_2DPrjZ2_S_TKWZLwkvE3V2oEKa3B-CkiavTvPf6vBHynS4hw</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Jackson, Gillian P</creator><creator>Jackson, Catriona E</creator><creator>Boland, Jason W</creator><creator>Featherstone, Imogen</creator><creator>Huang, Chao</creator><creator>Ogden, Margaret</creator><creator>Sartain, Kathryn</creator><creator>Siddiqi, Najma</creator><creator>Twiddy, Maureen</creator><creator>Pearson, Mark</creator><creator>Johnson, Miriam J</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9042-7600</orcidid><orcidid>https://orcid.org/0000-0001-7628-7421</orcidid><orcidid>https://orcid.org/0000-0001-6204-9158</orcidid><orcidid>https://orcid.org/0000-0001-5272-3057</orcidid><orcidid>https://orcid.org/0000-0001-5690-4920</orcidid></search><sort><creationdate>202404</creationdate><title>Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care</title><author>Jackson, Gillian P ; Jackson, Catriona E ; Boland, Jason W ; Featherstone, Imogen ; Huang, Chao ; Ogden, Margaret ; Sartain, Kathryn ; Siddiqi, Najma ; Twiddy, Maureen ; Pearson, Mark ; Johnson, Miriam J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p354t-a322eee9c771f446572040d5bad02c3724ec123f44e356b43e0f0b4d1653d1863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adherents</topic><topic>Clinical assessment</topic><topic>Clinical outcomes</topic><topic>COVID-19</topic><topic>Data collection</topic><topic>Delirium</topic><topic>Evaluation</topic><topic>Feasibility</topic><topic>Feasibility studies</topic><topic>Hospices</topic><topic>Implementation</topic><topic>Inpatient care</topic><topic>Intervention</topic><topic>Medical diagnosis</topic><topic>Medical screening</topic><topic>Original</topic><topic>Palliative care</topic><topic>Patient admissions</topic><topic>Patient participation</topic><topic>Patients</topic><topic>Risk assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jackson, Gillian P</creatorcontrib><creatorcontrib>Jackson, Catriona E</creatorcontrib><creatorcontrib>Boland, Jason W</creatorcontrib><creatorcontrib>Featherstone, Imogen</creatorcontrib><creatorcontrib>Huang, Chao</creatorcontrib><creatorcontrib>Ogden, Margaret</creatorcontrib><creatorcontrib>Sartain, Kathryn</creatorcontrib><creatorcontrib>Siddiqi, Najma</creatorcontrib><creatorcontrib>Twiddy, Maureen</creatorcontrib><creatorcontrib>Pearson, Mark</creatorcontrib><creatorcontrib>Johnson, Miriam J</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Palliative medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jackson, Gillian P</au><au>Jackson, Catriona E</au><au>Boland, Jason W</au><au>Featherstone, Imogen</au><au>Huang, Chao</au><au>Ogden, Margaret</au><au>Sartain, Kathryn</au><au>Siddiqi, Najma</au><au>Twiddy, Maureen</au><au>Pearson, Mark</au><au>Johnson, Miriam J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care</atitle><jtitle>Palliative medicine</jtitle><addtitle>Palliat Med</addtitle><date>2024-04</date><risdate>2024</risdate><volume>38</volume><issue>4</issue><spage>447</spage><epage>456</epage><pages>447-456</pages><issn>0269-2163</issn><eissn>1477-030X</eissn><abstract>Background:
Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management.
Aim:
To inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium).
Design:
With Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible.
Setting/participants:
In-patient admissions in three English hospices.
Results:
Between June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%–28%; delirium risk assessment 0%–16%; screening on admission 7%–35%.
Conclusions:
Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>38634231</pmid><doi>10.1177/02692163241236325</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9042-7600</orcidid><orcidid>https://orcid.org/0000-0001-7628-7421</orcidid><orcidid>https://orcid.org/0000-0001-6204-9158</orcidid><orcidid>https://orcid.org/0000-0001-5272-3057</orcidid><orcidid>https://orcid.org/0000-0001-5690-4920</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Palliative medicine, 2024-04, Vol.38 (4), p.447-456 |
| issn | 0269-2163 1477-030X |
| language | eng |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); SAGE Complete |
| subjects | Adherents Clinical assessment Clinical outcomes COVID-19 Data collection Delirium Evaluation Feasibility Feasibility studies Hospices Implementation Inpatient care Intervention Medical diagnosis Medical screening Original Palliative care Patient admissions Patient participation Patients Risk assessment |
| title | Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care |
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