Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non‐pharmacological delirium prevention program

Garrido, Maricel; Álvarez, Evelyn; Ponce, Daniela P.; Salech, Felipe; Tobar, Daniel; Tobar, Eduardo

doi:10.1002/gps.5425

Cited by 3 publications

(11 citation statements)

References 39 publications

(43 reference statements)

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“…The implementation studies targeted a range of health professionals including physicians [ 41 ], surgeons [ 42 – 44 ], anaesthesiologists [ 43 , 44 ], medical staff [ 45 – 52 ], nurses [ 41 – 45 , 47 – 62 ], nurse assistants [ 47 , 48 , 57 , 61 ], dietitians [ 42 , 48 , 52 , 61 ], physical therapists [ 47 , 50 , 59 , 61 , 63 , 64 ], occupational therapists [ 50 , 59 , 61 ], psychologists [ 50 ], multidisciplinary teams [ 42 , 47 , 50 , 52 , 61 , 65 , 66 ], as well as support services team members including food service staff, [ 49 ] and biomedical and sterile processing technicians. [ 43 ] Studies targeting more than one professional group or multidisciplinary teams more often used a determinant framework or a combination of more than one framework (Supplemental Fig.…”

Section: Resultsmentioning

confidence: 99%

“…No study detailed the rationale or criteria used for selecting a specific theoretical implementation framework over another. Fidelity to the implementation strategy was generally not reported, or when included was frequently limited to compliance with attending training or education sessions [ 47 , 51 , 53 , 58 , 61 ]. Only three studies reported overall compliance with the implementation approach [ 45 , 48 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

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Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review

Barnden

Snowdon

Lannin

et al. 2023

BMC Health Serv Res

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Background Health Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to assess the effectiveness of the application of theoretical implementation frameworks in inpatient healthcare settings to change processes of care and associated patient outcomes. Method We conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1st January 1995 to 15th June 2021. Two reviewers independently applied inclusion and exclusion criteria to potentially eligible studies. Eligible studies: implemented evidence-based care into an in-patient setting using a theoretical implementation framework applied prospectively; used a prospective study design; presented process of care or patient outcomes; and were published in English. We extracted theoretical implementation frameworks and study design against the Workgroup for Intervention Development and Evaluation Research (WIDER) Checklist and implementation strategies mapped to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We summarised all interventions using the Template for Intervention Description and Replication (TIDieR) checklist. We appraised study quality using the Item bank on risk of bias and precision of observational studies and the revised Cochrane risk of bias tool for cluster randomised trials. We extracted process of care and patient outcomes and described descriptively. We conducted meta-analysis for process of care and patient outcomes with reference to framework category. Results Twenty-five studies met the inclusion criteria. Twenty-one used a pre-post (no comparison), two a pre-post with a comparison, and two a cluster randomised trial design. Eleven theoretical implementation frameworks were prospectively applied: six process models; five determinant frameworks; and one classic theory. Four studies used two theoretical implementation frameworks. No authors reported their justification for selecting a particular framework and implementation strategies were generally poorly described. No consensus was reached for a preferred framework or subset of frameworks based on meta-analysis results. Conclusions Rather than the ongoing development of new implementation frameworks, a more consistent approach to framework selection and strengthening of existing approaches is recommended to further develop the implementation evidence base. Trial registration CRD42019119429.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review

Barnden

Snowdon

Lannin

et al. 2023

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

“…21 However, it is important to take into account that to modify behaviors in healthcare professionals, it is necessary not only to modify knowledge but also, and more importantly, to invoke changes in the beliefs and attitudes of health personnel that are sustainable over time. 34 The presence, intensity, and duration of hospital delirium negatively affect the nursing workload and quality of care since people with delirium required an average of 60 additional minutes of attention. 44 However, preventive interventions go beyond identifying patients at risk, affecting the structure of the hospital and the organizational issues of care.…”

Section: The Quality Of Hospital Carementioning

confidence: 99%

The ethical implications of preventing hospital delirium in older adults: A scoping review

et al. 2022

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Introduction Hospital delirium is a frequent, serious, costly, and underrecognized acute disorder of attention and cognition. Therefore, the prevention of hospital delirium is not only desirable for patients, caregivers, healthcare professionals, and the health system itself, but also a moral duty. Objective To identify and synthetize the main ethical aspects that arise related to the prevention of hospital delirium in patients 65 years and older. Methods A scoping review was carried out in Embase, Medline, and Web of Science (January 2009–January 2022). Articles published in English or Spanish analyzing any pharmacologic, non-pharmacologic, or multicomponent intervention for prevention of delirium in hospitalized patients aged 65 years and over were included. Results Twenty-seven studies were included. Based on the frequency of appearance and the relevance, our findings were organized into three main areas. The first one was related to the principle of nonmaleficence and collected findings about the iatrogenic causes of hospital delirium and the use of restraints systems. The second area analyzed the impact of delirium in patients, families, and healthcare professionals from a relational ethics perspective, and addressed the family presence as a factor to prevent delirium. Finally, the third area is related to the quality of care. Conclusion Prevention of delirium in hospitals is essential to avoid the discomfort and potential clinical complications of patients, as well as the suffering of their relatives, caregivers, and healthcare professionals. Policymakers and healthcare managers are encouraged to make the required efforts to prevent delirium in hospitalized older patients.

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“…Before this clinical trial, local pilot studies have shown some progress in this area. It has been reported that the incorporation of software technology through a "PREVEDEL" tablet is feasible and can be implemented on a hospital level, with possible effects on decreasing delirium [ 12 ] and the implementation of nPPD following a theoretical model improves the adherence of health personnel [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Software-guided (PREVEDEL) cognitive stimulation to prevent delirium in hospitalised older adults: study protocol

et al. 2023

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Background Delirium is a clinical condition characterised by acute and fluctuating deterioration of the cognitive state, generally secondary to an acute pathology. Delirium is associated with negative outcomes in older adults, such as longer hospitalisations, higher mortality, and short and medium-term institutionalisation. Randomised clinical trials have shown that delirium is preventable through non-pharmacological prevention measures, decreasing its incidence by 30–50%. These interventions include promoting physical activity, facilitating the use of glasses and hearing aids, cognitive stimulation, and providing frequent reorientation of time and space, among others. These measures are currently seldom applied in hospitals in Chile and around the world for reasons including the heavy workload of clinical staff, the lack of trained personnel, and in general the absence of a systematic implementation processes. We developed a software called PREVEDEL, which includes non-pharmacological strategies such as cognitive stimulation, early mobilisation, orientation, and pain assessment. We propose a randomised clinical trial to evaluate whether cognitive stimulation guided by PREVEDEL software prevents delirium status (full/subsyndromal delirium) in hospitalised older adults. Method A randomised controlled trial, with parallel, multicentre groups. We will recruite patients 65 years or older who have been hospitalised for less than 48 h in the general ward or the intermediate care units of four hospitals in Santiago, Chile. The participants in the intervention group will use a tablet with cognitive stimulation software for delirium prevention for five continuous days versus the control group who will use the tablet without the software. We will evaluate the incidence, duration, density of delirium, subsyndromal delirium with the Confusion Assessment Method, cognitive with the Montreal Cognitive Assessment, and functional status with the Functional Independence Measure at discharge. Moreover, we will evaluate the adherence to prevention measures, as well as demographic variables of interest. Discussion The use of cognitive PREVEDEL software could increase and improve the implementation of non-pharmacological prevention measures for delirium in hospitalised older adults, thus reducing its incidence and contributing to patients and health professionals. Trial registration NCT05108207 ClinicalTrials.gov. Registered 4 November 2021.

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Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non‐pharmacological delirium prevention program

Cited by 3 publications

References 39 publications

Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review

Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review

The ethical implications of preventing hospital delirium in older adults: A scoping review

Software-guided (PREVEDEL) cognitive stimulation to prevent delirium in hospitalised older adults: study protocol

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