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., …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