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An evolving approach to delirium: A mixed-methods process evaluation of a hospital-wide delirium program in New
Abdullah Ao Alhaidari1, Rosalind Ac Allen-Narker1
1Department of General Medicine, Wellington Regional Hospital, Wellington, New Zealand.
Objective:
A process evaluation was carried out to assess and potentially improve the design and implementation of a hospital-wide delirium program.
Methods:
A mixed-methods sequential-explanatory design was used; retrospective chart reviews for 100 older (75+) medical inpatients were conducted to measure nurses', doctors' and coders' adherence to key program processes following which interviews were conducted to identify potential barriers to implementation.
Results:
Delirium occurred in 49% of patients. Chart reviews revealed suboptimal adherence to the delirium risk assessment (66%), the Short Confusion Assessment Method (50% on admission, 58% during admission), documentation of delirium in clinical records (80%) and discharge letters (38%) and coding for delirium (49%). The major barriers to implementation identified were failure to recruit non-nursing staff, unclear goals and instructions, difficulties using the Short-CAM, time constraints with competing priorities and lack of outcome expectancy.
Conclusion:
A new delirium program was needed based on these findings.
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