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O-13 Improving the Detection, assessment, management and prevention of delirium in hospices: The DAMPen-Delirium feasibility study
  1. Gillian Jackson1,
  2. Mark Pearson1,
  3. Catriona Jackson2,
  4. Jason Boland1,
  5. Imogen Featherstone3,
  6. Chao Huang5,
  7. Margaret Ogden1,
  8. Kathryn Sartain4,
  9. Najma Siddiqi3,
  10. Maureen Twiddy5 and
  11. Miriam Johnson1
  1. 1Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  2. 2Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  3. 3Department of Health Sciences, University of York, UK
  4. 4York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
  5. 5Institute of Clinical and Applied Health Research, Hull York Medical School, University Of Hull, UK


Background Delirium causes severe distress for patients, families, and staff. One-third of people admitted to adult palliative care units have delirium and two-thirds develop delirium during their stay (Watt, Momoli, Ansari, et al., 2019. Palliat Med. 33:865), yet implementation of clinical guidelines is poor (NICE. Delirium: prevention, diagnosis and management - Clinical Guideline 103, 2010). Strategies are needed to address the gap between knowledge and action (Featherstone, Hosie, Siddiqi, et al., 2021. Palliat Med. 35: 988).

Aim To assess the feasibility of timely and reliable clinical record data collection in hospices with different socio-economic profiles and record-keeping methods.

Methods Phase one of the ongoing feasibility study collects clinical record data (demographic; evidence of delirium; [Inouye, Leo-Summers, Zhang, et al., 2005. J Am Geriatr Soc. 53: 312] guideline-adherent delirium care) from 50 consecutive in-patient admissions at four hospices. Data collection will be repeated following implementation of the co-designed Creating Learning Environments for Compassionate Care-Palliative (CLECC-Pal) intervention to support delirium guideline-adherence. The variation around baseline number of patient days with delirium will be calculated to inform the sample size needed for a future multi-site effectiveness study.

Results To date, 100 clinical records have been reviewed from two hospices. In-patient characteristics differ considerably in age (mean 89 vs. 70 years), deprivation quintile (80% vs. 38% in least-deprived) and diagnosis (90% vs. 72% cancer). Overall, two-thirds of patients had a delirium episode during admission, for whom >75% of their in-patient days were delirium days. A delirium diagnosis was documented by the clinical team in <10% of cases. Guideline-adherent delirium risk assessment and screening was not documented in clinical records.

Conclusion Our ongoing study is demonstrating: i) the feasibility of systematically and reliably collecting clinical record data about delirium occurrence and management; ii) the gap between need for delirium care and action (low guideline-adherence). Our emerging findings demonstrate the imperative for, and feasibility of, conducting a multi-site effectiveness study of the CLECC-Pal strategy for improving guideline-adherence in delirium care.

For more on this study, see also Poster P-104: Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices: The DAMPen-Delirium co-design process, by Mark Pearson et al.

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