Improving the quality of delirium practices in a large Australian tertiary hospital: an evidence implementation initiative

Abstract

Objective: The aim of the evidence implementation initiative was to improve the quality of care delivered to hospitalised patients at risk of, or with, delirium through the implementation of best practice recommendations.Background: Delirium is a prevalent serious medical condition that remains unrecognised or misdiagnosed in acute hospitals and is therefore left untreated. This paper reports on a hospital-wide quality improvement project which was undertaken in recognition of the Australian Delirium Clinical Care Standard and as a response to the cumulative rate of hospital-acquired delirium within a health organisation in New South Wales, Australia. Methods:The quality improvement project used the JBI (formerly known as Joanna Briggs Institute) evidence implementation framework. Briefly, the JBI evidence implementation approach is grounded in the audit, feedback and re-audit process along with a structured process for the identification and management of barriers to compliance with recommended clinical practices. Twelve nurses, who received support from external facilitators (implementation researchers), acted as delirium champions.Results: Baseline audit of 143 patient notes showed poor compliance (range 6% -67%) to recommended practices relating to screening, assessment, prevention and management of delirium. Barriers analysis revealed nurse-related (eg. lack of knowledge) and organisational level factors (e.g. absence of a hospital-wide policy/procedure for delirium management). A multicomponent strategy was implemented by all delirium champions in their respective units/wards. Follow-up audit of 151 patient notes demonstrated significant improvements in compliance with best practice recommendations for all aspects of delirium care.

Facilitation as a component of evidence implementation: a multinational perspective

“…Case study 1: improving delirium practices in a large tertiary hospital: an Australian perspective In Australia, delirium has been identified by the Australian Commission on Safety and Quality in Healthcare (ACSQHC) as a high priority area for quality improvement. 7 The ACSQHC released the Delirium Clinical Care Standard to ensure that patients at risk of delirium receive preventative strategies, and those with delirium receive the best possible treatment. 6 In 2018, one of the largest tertiary hospitals in New South Wales recorded 299 episodes of hospital-acquired delirium; this delirium rate was higher compared with their peer hospitals.…”

“…As a result, and in recognition of the Delirium Clinical Care Standard, 6 the hospital launched a hospital-wide quality improvement initiative to facilitate the implementation of best practice in delirium care and optimize hospitalized patient outcomes. 7 At the commencement of the project, a call for expressions of interest were sought from registered nurses in the hospital who were interested in acting as a change agent for each participating unit or ward. These nurses had to have a strong interest in delirium care and possess leadership skills and undergo the JBI at follow-up Patients who continued to experience pain were increasingly referred to pain specialists, which rarely occurred prior to the implementation initiative EITP; they were referred to in the project as delirium champions.…”

“…Aggression is defined as angry feelings or behaviors, such as yelling, screaming, swearing, namecalling, and bullying, which if not addressed often escalate to physical violence within the behavioral health unit. 7 Violence reduction strategies in the behavioral health unit consist of both primary and secondary prevention strategies. 10 Primary prevention strategies aim to stop violence before it occurs.…”

“…In Australia, delirium has been identified by the Australian Commission on Safety and Quality in Healthcare (ACSQHC) as a high priority area for quality improvement 7 . The ACSQHC released the Delirium Clinical Care Standard to ensure that patients at risk of delirium receive preventative strategies, and those with delirium receive the best possible treatment 6 .…”

“…In 2018, one of the largest tertiary hospitals in New South Wales recorded 299 episodes of hospital-acquired delirium; this delirium rate was higher compared with their peer hospitals. As a result, and in recognition of the Delirium Clinical Care Standard, 6 the hospital launched a hospital-wide quality improvement initiative to facilitate the implementation of best practice in delirium care and optimize hospitalized patient outcomes 7 …”