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An evolving approach to delirium: A mixed‐methods process evaluation of a hospital‐wide delirium program in New Zealand
Author(s) -
Alhaidari Abdullah AO,
AllenNarker Rosalind AC
Publication year - 2017
Publication title -
australasian journal on ageing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.63
H-Index - 34
eISSN - 1741-6612
pISSN - 1440-6381
DOI - 10.1111/ajag.12406
Subject(s) - delirium , medical record , confusion , chart , coding (social sciences) , medicine , documentation , nursing , medical emergency , psychology , intensive care medicine , computer science , statistics , mathematics , psychoanalysis , programming language , radiology
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.