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A Pilot Randomized Controlled Trial of the Feasibility of a Multicomponent Delirium Prevention Intervention Versus
Karen L Rice1, Marsha J Bennett, Linley Berger
1Karen L. Rice, DNS, APRN, ACNS-BC, ANP Nurse Scientist & Director, The Center for Nursing Research, Ochsner Medical Center, New Orleans, Louisiana. Marsha J. Bennett, DNS, APRN, ACRN Professor, Louisiana State University Health Sciences Center, School of Nursing, New Orleans. Linley Berger, MCD, CCC-SLP Speech Language Pathologist, Ochsner Medical Center, New Orleans, Louisiana. Bethany Jennings, MN, APRN, FNP-C Stroke Program Director, Ochsner Medical Center, New Orleans, Louisiana. Lynn Eckhardt, MSN, APRN, GNP-BC Nurse Practitioner, Neurology Clinic, Ochsner Medical Center, New Orleans, Louisiana. Nicole Fabré-LaCoste, PharmD, BCPS, CGP Clinical Pharmacist Residency Program Director, Ochsner Medical Center, New Orleans, Louisiana. David Houghton, MD, MPH Chief, Division of Memory and Movement Disorders, Ochsner Medical Center, New Orleans, Louisiana. Gabriel Vidal, MD Vascular and Interventional Neurologist, Ochsner Medical Center, New Orleans, Louisiana. Toby Gropen, MD Chief, Division of Vascular Neurology, Ochsner Medical Center, New Orleans, Louisiana. Erica Diggs, MD Hospitalist, Division of Internal Medicine, Ochsner Medical Center, New Orleans, Louisiana. Erin Barry, MSN, RN, CNRN Neuro-Critical Care Clinical Nurse Specialist, Ochsner Medical Center, New Orleans, Louisiana. Jennilee St. John, MSN, APRN, AGCNS-BC, CCRN Neuro-Critical Care Clinical Nurse Specialist, Ochsner Medical Center, New Orleans, Louisiana. Sheena Mathew, PharmD Clinical Pharmacist, Ochsner Medical Center, New Orleans, Louisiana. Allison Egger, MPH Biostatistician, Ochsner Medical Center, New Orleans, Louisiana. Stephanie Ryan, DNP, FNP-C Stroke Team Nurse Practitioner, Ochsner Medical Center, New Orleans, Louisiana. Raymond Egger, BSN, RN, CNRN Stroke Central Coordinator, Ochsner Medical Center, New Orleans, Louisiana. David Galarneau, MD Vice Chairman, Department of Psychiatry, Ochsner Medical Center, New Orleans, Louisiana. Kenneth Gaines, MD Director, Ochsner's Neuroscience Institute, Ochsner Medical Center, New Orleans, Louisiana. E. Wesley Ely, MD, MPH Professor of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and the Veteran's Affairs Geriatric Research Education Clinical Center (GRECC) of the VA Tennessee Valley Healthcare System, Nashville.
Background:
Delirium after acute stroke is a serious complication. Numerous studies support a benefit of multicomponent interventions in minimizing delirium-related complications in at-risk patients, but this has not been reported in acute stroke patients. The purpose of this study was to explore the feasibility of conducting a randomized (delirium care) versus usual standardized stroke care (usual care) in reducing delirium in acute stroke.
Objective:
This pilot study assessed the feasibility of (1) enrollment within the 48-hour window when delirium risk is greatest, (2) measuring cognitive function using the Montreal Cognitive Assessment, (3) delivering interventions 7 days per week, and (4) determining delirium incidence in stroke-related cognitive dysfunction.
Methods:
A 2-group randomized controlled trial was conducted. Patients admitted with ischemic and hemorrhagic strokes and 50 years or older, English speaking, and without delirium on admit were recruited, consented, and randomized to usual care or delirium care groups.
Results:
Data from 125 subjects (delirium care, n = 59; usual care, n = 66) were analyzed. All Montreal Cognitive Assessment subscales were completed by 86% of subjects (delirium care, mean [SD], 18.14 [6.03]; usual care, mean [SD], 17.61 [6.29]). Subjects in the delirium care group received a mean of 6.10 therapeutic activities (range, 2-23) and daily medication review by a clinical pharmacist using anticholinergic drug calculations. Delirium incidence was 8% (10/125), 3 in the delirium care group and 7 in the usual care group.
Conclusion:
Findings support the feasibility of delivering a multicomponent delirium prevention intervention in acute stroke and warrants testing intervention effects on delirium outcomes and anticholinergic medication administration.
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