Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care

Jackson, Gillian P.; Jackson, Catriona; Boland, Jason W.; Featherstone, Imogen; Huang, Chao; Ogden, Margaret; Sartain, Kathryn; Siddiqi, Najma; Twiddy, Maureen; Pearson, Mark; Johnson, Miriam J.

Abstract

Background: Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management. Aim: To inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium). Design: With Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible. Setting/participants: In-patient admissions in three English hospices. Results: Between June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%–28%; delirium risk assessment 0%–16%; screening on admission 7%–35%. Conclusions: Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study.

Citation

Jackson, G. P., Jackson, C., Boland, J. W., Featherstone, I., Huang, C., Ogden, M., Sartain, K., Siddiqi, N., Twiddy, M., Pearson, M., & Johnson, M. J. (2024). Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care. Palliative medicine, 38(4), 447-456. https://doi.org/10.1177/02692163241236325

• Journal Article Type: Article
• Acceptance Date: Feb 7, 2024
• Online Publication Date: Apr 18, 2024
• Publication Date: Apr 1, 2024
• Deposit Date: Feb 19, 2024
• Publicly Available Date: Apr 29, 2024
• Journal: Palliative Medicine
• Print ISSN: 0269-2163
• Electronic ISSN: 1477-030X
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 38
• Issue: 4
• Pages: 447-456
• DOI: https://doi.org/10.1177/02692163241236325
• Keywords: Delirium; Feasibility; Guideline adherence; Hospices; Implementation
• Public URL: https://hull-repository.worktribe.com/output/4551933