Open Access Open Access  Restricted Access Subscription or Fee Access

No longer lost in translation: study protocol for preventing delirium post hip fracture

Tarandeep Oberai, Kate Laver, Maggie Killington, Richard Woodman, Maria Crotty, Jaarsma Ruurd

Abstract


Introduction: Hip fractures are serious injuries commonly experienced by older adults. Delirium has been identified as the most frequent post-operative complication among hospitalized older people, following hip fracture. A quality assurance audit within our hospital demonstrated that delirium screening, prevention and management were not performed routinely or systematically. This study protocol describes an implementation research project which aims to implement and evaluate the effect of an intervention bundle to prevent delirium in patients with hip fracture admitted to an acute orthopaedic ward.

Methods: This implementation research project seeks to assess whether the intervention bundle reduces the incidence of delirium in patients with hip fracture patients identified via the use of a validated tool in screening delirium. We will also examine the length of hospital stay, duration of delirium episode and the prevalence of the use of a validated tool to screen delirium.

Intervention: Specific intervention strategies, informed by contemporary Behaviour Change Wheel Framework have been selected to address the identified barriers. The final components of the intervention are care pathway, education, audit and feedback, change champions, adaptation of forms and documentation and infographics.

Conclusion: This study describes an implementation project which evaluates the effect of a delirium prevention bundle on incidence of delirium in patients with hip fractures. The clinical goal of the delirium prevention care bundle is to bridge the gap between the current and best practice in delirium recognition, prevention and management.

Keywords


Acute orthopaedics, cognitive impairment, delirium, delirium screening, diagnosis, evaluation, hip fracture, implementation, intervention, mortality, multidisciplinary approach, person-centered healthcare, prevention care pathway, prevention of delirium,

Full Text:

PDF

References


Magaziner, J., Hawkes, W., Hebel, J.R., Zimmerman, S.I., Fox, K.M., Dolan, M., Felsenthal, G. & Kenzora, J. (2000). Recovery from hip fracture in eight areas of function. Journal of Gerontology Series A, Biological Sciences and Medical Sciences 55 (9) M498-507.

Marks, R., Allegrante, J.P., Ronald MacKenzie, C. & Lane, J.M. (2003). Hip fractures among the elderly: causes, consequences and control. Ageing Research Reviews 2 (1) 57-93.

Hirsch, C.H., Sommers, L., Olsen, A., Mullen, L. & Winograd, C.H. (1990). The natural history of functional morbidity in hospitalized older patients. Journal of the American Geriatrics Society 38 (12) 1296-1303.

Moran, C.G., Wenn, R.T., Sikand, M. & Taylor, A.M. (2005). Early mortality after hip fracture: is delay before surgery important? Journal of Bone and Joint Surgery 87 (3) 483-489.

Rae, H.C., Harris, I.A., McEvoy, L. & Todorova, T. (2007). Delay to surgery and mortality after hip fracture. ANZ Jouirnal of Surgery 77 (10) 889-891.

Brauer, C., Morrison, R.S., Silberzweig, S.B. & Siu, A.L. (2000). The cause of delirium in patients with hip fracture. Archives of Internal Medicine 160 (12) 1856-1860.

Edlund, A., Lundstrom, M., Brannstrom, B., Bucht, G. & Gustafson, Y. (2001). Delirium before and after operation for femoral neck fracture. Journal of the American Geriatrics Society 49 (10) 1335-1340.

Gustafson, Y., Berggren, D., Brannstrom, B., Bucht, G., Norberg, A., Hansson, L.I. & Winblad, B. (1988). Acute confusional states in elderly patients treated for femoral neck fracture. Journal of the American Geriatrics Society 36 (6) 525-530.

Marcantonio, E.R., Flacker, J.M., Wright, R.J. & Resnick, N.M. (2001). Reducing delirium after hip fracture: a randomized trial. Journal of the American Geriatrics Society 49 (5) 516-522.

Cole, M.G. (2004). Delirium in elderly patients. American Journal of Geriatric Psychiatry 12 (1) 7-21.

Francis, J., Martin, D. & Kapoor, W.N. (1990). A prospective study of delirium in hospitalized elderly. Journal of the American Medical Association 263 (8) 1097-1101.

McCusker, J., Cole, M., Dendukuri, N., Belzile, E. & Primeau, F. (2001). Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. Canadian Medical Association Journal 165 (5) 575-583.

Rockwood, K., Cosway, S., Carver, D., Jarrett, P., Stadnyk, K. & Fisk, J. (1999). The risk of dementia and death after delirium. Age and Ageing 28 (6) 551-556.

Harris, D.P., Chodosh, J., Vassar, S.D., Vickrey, B.G. & Shapiro, M.F. (2009). Primary care providers' views of challenges and rewards of dementia care relative to other conditions. Journal of the American Geriatrics Society 57 (12) 2209-2216.

Hare, M., Wynaden, D., McGowan, S., Landsborough, I. & Speed, G. (2008). A questionnaire to determine nurses' knowledge of delirium and its risk factors. Contemporary Nurse 29 (1) 23-31.

Steis, M.R. & Fick, D.M. (2012). Delirium superimposed on dementia: accuracy of nurse documentation. Journal of Gerontological Nursing 38 (1) 32-42.

Oberai, T., Laver, K., Crotty, M., Killington, M. & Jaarsma, R. (2018). Effectiveness of multicomponent interventions on incidence of delirium in hospitalized older patients with hip fracture: a systematic review. International Psychogeriatrics 30 (4) 481-492.

Australian Commission on Safety and Quality in Health Care. (2016). Delirium Clinical Care Standard. Sydney: ACSQHC. Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2016/07/Delirium-Clinical-Care-Standard-Web-PDF.pdf.

Eccles, M.P. & Mittman, B.S. (2006). Welcome to implementation science. Implementation Science 1,1.

Hodgson, N.A. & Gitlin, L.N. (2016). The role of implementation science in behavioral intervention research. In: Behavioral intervention research: designing, evaluating and implementing. Gitlin, L.N. & Czaja, S.J. (Eds). New York: Springer Publishers.

Graham, I.D., Logan, J., Harrison, M.B., Straus, S.E., Tetroe, J., Caswell, W. & Robinson, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions 26 (1) 13-24.

Wilson, K.M., Brady, T.J., Lesesne, C. & NCCDPHP Work Group on Translation. (2011). An organizing framework for translation in public health: the Knowledge to Action Framework. Preventing Chronic Disease 8 (2) A46.

Grimshaw, J.M., Shirran, L., Thomas, R., Mowatt, G., Fraser, C., Bero, L. Grilli, R., Harvey, E., Oxman, A. & O’Brien, M.A. (2001). Changing provider behavior: an overview of systematic reviews of interventions. Medical Care 39 (Supplement 8) II2-II45.

Michie, S., van Stralen, M.M. & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science 6 (1) 42.

Bernal, J.L., Cummins, S. & Gasparrini, A. (2017). Interrupted time series regression for the evaluation of public health interventions: a tutorial. International Journal of Epidemiology 46 (1) 348-355.

Shadish, W.R., Cook, T.D. & Campbell, D.T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Internet Archive: Wadsworth Cengage Learning.

Wagner, A.K., Soumerai, S.B., Zhang, F. & Ross‐Degnan, D. (2002). Segmented regression analysis of interrupted time series studies in medication use research. Journal of Clinical Pharmacy and Therapeutics 27 (4) 299-309.

Penfold, R.B. & Zhang, F. (2013). Use of Interrupted Time Series Analysis in Evaluating Health Care Quality Improvements. Academic Pediatrics 13 (6) S38-S44.

Fretheim, A., Zhang, F., Ross-Degnan, D., Oxman, A.D., Cheyne, H., Foy, R., Goodacre, S., Herrin, J., Kerse, N., McKinlay, R.J., Wright, A. & Soumerai, S.B. (2015). A reanalysis of cluster randomized trials showed interrupted time-series studies were valuable in health system evaluation. Journal of Clinical Epidemiology 68 (3) 324-333.

Donaldson, A. & Finch, C.F. (2012). Planning for implementation and translation: seek first to understand the end-users' perspectives. British Journal of Sports Medicine 46 (5) 306-307.

De Allegri, M., Schwarzbach, M., Loerbroks, A. & Ronellenfitsch, U. (2011). Which factors are important for the successful development and implementation of clinical pathways? A qualitative study. BMJ Quality & Safety 20 (3) 203-208.

Gurzick, M. & Kesten, K.S. (2010). The impact of clinical nurse specialists on clinical pathways in the application of evidence-based practice. Journal of Professional Nursing 26 (1) 42-48.

Kinsman, L., James, E. & Ham, J. (2004). An interdisciplinary, evidence-based process of clinical pathway implementation increases pathway usage. Lippincotts Case Management 9 (4) 184-196.

Al-Qadheeb, N.S., Hoffmeister, J., Roberts, R., Shanahan, K., Garpestad, E. & Devlin, J.W. (2013). Perceptions of nurses and physicians of their communication at night about intensive care patients' pain, agitation, and delirium. American Journal of Critical Care 22 (5) e49-61.

Kjorven, M., Rush, K. & Hole, R. (2011). A discursive exploration of the practices that shape and discipline nurses' responses to postoperative delirium. Nursing Inquiry 18 (4) 325-335.

Proctor, E.K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C. & Mittman, B. (2009). Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges. Administration and Policy in Mental Health 36 (1) 24-34.




DOI: http://dx.doi.org/10.5750/ejpch.v7i1.1607

Refbacks

  • There are currently no refbacks.