Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation

Trogrlić, Zoran; Jagt, Mathieu van der; Achterberg, Theo van; Ponssen, H. H.; Schoonderbeek, J; Schreiner, Frodo; Verbrugge, Serge; Dijkstra, Annemieke; Bakker, Jan; Ista, Erwin

doi:10.1136/bmjoq-2019-000871

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…Delirium was assessed with the CAM-ICU in three participating ICUs and in the fourth ICU the ICDSC was used. Delirium assessment was performed three times daily (once per 8-h shift) by ICU nurses, previously trained to use the CAM-ICU or ICDSC (depending on the hospital) [ 10 , 16 ]. Hyperactive delirium was defined as a persistently positive RASS score (+ 1 to + 4) during all positive delirium assessments throughout the entire ICU stay, whereas a persistently negative or neutral RASS score (0 to − 3) at each positive delirium assessment was defined as hypoactive delirium [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study

et al. 2022

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Background The prognostic implication of delirium subtypes in critically ill medical and surgical patients is scarcely investigated. The objective was to determine how delirium subtypes are associated with hospital mortality and other clinical outcomes. Methods We performed a secondary analysis on data from a prospective multicenter study aimed at implementation of delirium-oriented measures, conducted between 2012 and 2015 in The Netherlands. We included adults (≥ 18 years) admitted to the medical or surgical intensive care unit (ICU). Exclusion criteria were neurological admission diagnosis, persistent coma or ICU readmissions. Delirium was assessed using the Confusion Assessment Method-ICU or Intensive Care Delirium Screening Checklist, and delirium subtypes (hypoactive, hyperactive, or mixed) were classified using the Richmond Agitation–Sedation Scale. The main outcome was hospital mortality. Secondary outcomes were ICU mortality, ICU length of stay, coma, mechanical ventilation, and use of antipsychotics, sedatives, benzodiazepines and opioids. Results Delirium occurred in 381 (24.4%) of 1564 patients (52.5% hypoactive, 39.1% mixed, 7.3% hyperactive). After case-mix adjustment, patients with mixed delirium had higher hospital mortality than non-delirious patients (OR 3.09, 95%CI 1.79–5.33, p = 0.001), whereas hypoactive patients did not (OR 1.34, 95%CI 0.71–2.55, p = 0.37). Similar results were found for ICU mortality. Compared to non-delirious patients, both subtypes had longer ICU stay, more coma, increased mechanical ventilation frequency and duration, and received more antipsychotics, sedatives, benzodiazepines and opioids. Except for coma and benzodiazepine use, the most unfavourable outcomes were observed in patients with mixed delirium. Conclusions Patients with mixed delirium had the most unfavourable outcomes, including higher mortality, compared with no delirium. These differences argue for distinguishing delirium subtypes in clinical practice and future research. Trial registration ClinicalTrials.gov NCT01952899.

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Section: Methodsmentioning

confidence: 99%

Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study

et al. 2022

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“…Notably, the mediating effect remained robust even after the adjustment of age, hospital type, and training experience. (Emme, 2020;Selim & Ely, 2017;Trogrlić et al, 2017;Xing et al, 2017). This deficit, relying on experience rather than validated tools, may hinder proper nurses with higher educational attainment and higher academic titles displayed a higher level of knowledge generally.…”

Section: Mediation Analysis Of Knowledge Attitude and Practice Regard...mentioning

confidence: 99%

Knowledge, attitude, and practice regarding postoperative delirium among cardiac surgery nurses: A cross‐sectional multi‐centre study

Zhou

Wang

et al. 2023

Journal of Clinical Nursing

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Aims and Objectives: To examine knowledge, attitude, and practice regarding postoperative delirium and the relationships among cardiac surgery nurses in China.Background: Postoperative delirium is a prevalent and devastating complication following cardiac surgery. Nurses play a part in multi-disciplinary collaboration for preventing and managing postoperative delirium, of whom knowledge, attitude, and practice are essential. Design:A cross-sectional multi-centre study.Methods: Nurses from cardiac surgery wards and intensive care units of five tertiary hospitals in Wuhan, Hubei Province, China were enrolled. Data were gathered online using a self-administered questionnaire. Student's t-test, or analysis of variance, or non-parametric tests were performed to compare differences across groups.Bootstrapping mediation analysis was conducted to examine the relationship between knowledge, attitude, and practice. The STROBE checklist was used for the reporting of this study. Results:Of 429 nurses, a moderate level of knowledge and high levels of attitude and practice regarding postoperative delirium were revealed. Nurses with higher education, higher academic title, 5-10 years of practice in nursing and cardiac surgery nursing exhibited increased knowledge. With advanced age, practice in a specialised hospital, and training experience, nurses reported a better degree of practice.Attitude played a full mediating effect in the relationship between knowledge and practice, accounting for 81.82% of the total effects. Conclusions: Knowledge, attitude, and practice regarding postoperative delirium are promising among Chinese cardiac surgery nurses, with knowledge of screening tools and perioperative nonpharmacological interventions and practice of screening in need of enhancement. Attitudes act as an intermediary between knowledge and practice regarding postoperative delirium.

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“…An extensive body of research demonstrates the benefits of staff training in promoting effective delivery of novel ICU interventions [13,[20][21][22][23][24]. Relevant knowledge and skills, familiarity with the intervention, and 'buy-in' to its aims and purpose can all be enabled.…”

Section: Implications Of the Evidence For Trial Theorymentioning

confidence: 99%

Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A process evaluation

Jordan,

Tume,

Clarke

et al. 2023

PLoS ONE

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Background Prolonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes. Methods 10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics. Results The intervention led to a reduced duration of IMV (adjusted median difference– 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59–85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership. Conclusions The SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect. Trial registration isrctn.org Identifier: ISRCTN16998143.

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Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation

Cited by 8 publications

References 24 publications

Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study

Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study

Knowledge, attitude, and practice regarding postoperative delirium among cardiac surgery nurses: A cross‐sectional multi‐centre study

Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A process evaluation

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