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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