Implementing a Rapid, Two-Step Delirium Screening Protocol in Acute Care: Barriers and Facilitators

Area of Science:

• Geriatric Medicine
• Healthcare Implementation Science
• Clinical Nursing Research

Background:

• Effective delirium identification is crucial for improving health outcomes in older adults and reducing healthcare costs.
• Existing protocols may lack efficiency, necessitating the development and testing of rapid identification methods.
• The ultra-brief confusion assessment method (UB-CAM) is a two-step protocol designed for quick delirium screening.

Purpose of the Study:

• To describe the barriers and facilitators encountered during the implementation of the UB-CAM protocol.
• To evaluate the utility, acceptability, and feasibility of the UB-CAM in hospitalized older adults.
• To understand clinician perspectives on a novel, rapid delirium identification system.

Main Methods:

• A qualitative descriptive design was employed, utilizing observational data collection and semi-structured interviews.
• Field researchers observed the administration of the UB-CAM (n=767) in an urban academic medical center and a community teaching hospital.
• Thematic analysis of observational categories (structural, organizational, patient, clinician, innovation) and clinician interviews (n=231) informed the findings.

Main Results:

• The UB-CAM received positive reception from hospitalists, registered nurses, and nursing assistants (NAs).
• Six key themes emerged: physical setting, practice environment, role integration, adaptive techniques, patient responses, and systematic assessment.
• The interplay of these themes determined whether they acted as barriers or facilitators, highlighting the importance of context.

Conclusions:

• This study is among the first to test a two-step delirium identification process involving NAs.
• Clinicians generally support delirium identification, underscoring the need for a multifaceted implementation approach.
• Contextualized, systemic strategies are essential for the successful implementation and evaluation of delirium screening protocols.