Evaluating the effectiveness of educational interventions to prevent delirium
Corresponding Author
Anne Pamela Frances Wand
Sydney South West Area Health Service; and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Dr Anne Pamela Frances Wand, Aged Care Assessment Team, Outpatient Department, Canterbury Hospital. Email: [email protected]Search for more papers by this authorCorresponding Author
Anne Pamela Frances Wand
Sydney South West Area Health Service; and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Dr Anne Pamela Frances Wand, Aged Care Assessment Team, Outpatient Department, Canterbury Hospital. Email: [email protected]Search for more papers by this authorAbstract
The aim of this study was to combine knowledge about how clinicians learn with a review of educational interventions to prevent delirium in hospitalised patients. The primary aim was to evaluate the effectiveness of approaches to delirium education. A detailed search of educational and medical databases was undertaken. The type of intervention used was classified according to the PRECEED model of Green and colleagues, using factors relevant to behaviour change in health promotion. The effectiveness of the intervention was determined by assessing changes in staff performance and patient outcomes. Nineteen studies of variable design and quality were identified. Studies using predisposing, enabling and reinforcing strategies together were more often effective in producing changes in staff behaviour and patient outcomes. Education and guidelines used together or in combination have little effect. When strategies to enable and reinforce changes in clinical practice are used together with education sessions, outcomes for patients are more positive.
References
- 1 Siddiqi N, Hose A, Holmes J. Occurrence and outcome of delirium in medical in-patients: A systematic literature review. Age and Ageing 2006; 35: 350–364.
- 2 Lundstrom M, Olofsson B, Stenvall M et al. Postoperative delirium in old patients with femoral neck fracture: A randomised intervention study. Aging Clinical and Experimental Research 2007; 19: 178–186.
- 3 Adamis D, Treloar A, Martin F, Macdonald A. Recovery and outcomes of delirium in elderly medical inpatients. Archives of Gerontology and Geriatrics 2006; 43: 289–298.
- 4 Kat MG, Vreeswijk R, de Jonghe JFM et al. Long-term cognitive outcome of delirium in elderly hip surgery patients. Dementia and Geriatric Cognitive Disorders 2008; 26: 1–8.
- 5 Cole MG, Cusker J, Bellavance F et al. Systematic detection and multidisciplinary care of delirium in older medical inpatients: A randomised trial. Canadian Medical Association Journal 2002; 167: 753–759.
- 6 Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS. Multicomponent geriatric intervention for elderly patients with delirium: A randomised, controlled trial. Journal of Gerontology 2006; 61A: 176–181.
- 7 Green L, Kreuter M, Deeds S, Partridge K. Health Education Planning: A Diagnostic Approach. Palo Alto, CA: Mayfield Press, 1980.
- 8 Davis DA, Thompson MA, Oxman AD, Haynes B. Evidence for the effectiveness of CME: A review of 50 randomised controlled trials. Journal of the American Medical Association 1992; 268: 1111–1117.
- 9 Pretto M, Spirig R, Milisen K et al. Effects of an interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) on nursing workload: A pilot study. International Journal of Nursing Studies 2009; 46: 804–812.
- 10 Lundstrom M, Edlund A, Lundstrom G, Gustafson Y. Reorganisation of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures. Scandinavian Journal of Caring Sciences 1999; 13: 193–200.
- 11 Brymer C, Cavanagh P, Denomy E, Wells K, Cook C. The effect of a geriatric education program on emergency nurses. Journal of Emergency Nursing 2001; 27: 27–32.
- 12 St Pierre J. Delirium: A process improvement approach to changing prescribing practices in a community teaching hospital. Journal of Nursing Care Quality 2005; 20: 244–250.
- 13 Young LJ, George J. Do guidelines improve the process and outcomes of care in delirium? Age and Ageing 2003; 32: 525–528.
- 14 Robinson S, Rich C, Weitzel T et al. Delirium prevention for cognitive, sensory, and mobility impairments. Research and Theory for Nursing Practice: An International Journal 2008; 22: 103–113.
- 15 Wong DM, Bruce JJ, Bruce DG. Quality project to prevent delirium after hip fracture. Australasian Journal on Ageing 2005; 24: 174–177.
- 16 Nagley SJ. Predicting and preventing confusion in your patients. Journal of Geronotological Nursing 1986; 12: 27–31.
- 17 Wanich CK, Sullivan-Marx EM, Gottlieb GL, Johnson JC. Functional status outcomes of a nursing intervention in hospitalised elderly. Image – The Journal of Nursing Scholarship 1992; 24: 201–220.
- 18 Simon L, Jewell N, Brojel J. Management of acute delirium in hospitalised elderly: A process improvement project. Geriatric Nursing 1997; 18: 150–154.
- 19 Rapp CG, Onega LL, Tripp-Reimer T et al. Unit-based acute confusion resource nurse: An educational program to train staff nurses. The Gerontologist 1998; 38: 628–632.
- 20 Milisen K, Foreman MD, Abraham IL et al. A nurse-led interdisciplinary intervention program for delirium in elderly hip fracture patients. Journal of American Geriatric Society 2001; 49: 523–532.
- 21 Lundstrom M, Edlund A, Karlsson S et al. A multifactorial intervention program reduces the duration of delirium, length of hospitalisation, and mortality in delirious patients. Journal of the American Geriatrics Society 2005; 53: 622–682.
- 22 Naughton BJ, Saltzman S, Ramadan F, Chadha N, Priore R, Mylotte JM. A multifactorial intervention to reduce prevalence of delirium and shorten hospital length of stay. Journal of the American Geriatric Society 2005; 53: 18–23.
- 23 Tabet N, Hudson S, Sweeney V et al. An educational intervention can prevent delirium on acute medical wards. Age and Ageing 2005; 34: 152–156.
- 24 Benedict L, Hazelett S, Fleming E et al. Prevention, detection and intervention with delirium in an acute care hospital: A feasibility study. International Journal of Older People Nursing 2009; 4: 194–202.
- 25 Vidan MT, Sanchez E, Alonso M, Montero B, Ortiz J, Serra JA. An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalisation in elderly patients. Journal of the American Geriatrics Society 2009; 57: 2029–2036.
- 26 Akechi T, Ishiguro C, Okuyama T. Delirium training program for nurses. Psychosomatics 2010; 51: 106–111.
- 27 Jamtvedt G, Young JM, Kristoffersen DT et al. Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2010; Issue 7. Art. No. CD000259. DOI: 10.1002/14651858.CD000259.pub2.
- 28 Inouye SK, Bogardus ST, Charpentier PA et al. A multicomponent intervention to prevent delirium in hospitalised older patients. New England Journal of Medicine 1999; 340: 669–676.
- 29 Caplan GA, Harper EL. Recruitment of Volunteers to improve vitality in the elderly: The REVIVE study. Internal Medicine Journal 2007; 37: 95–100.
- 30 Marcantonio ER, Flacker JM, Wright J, Resnick NM. Reducing delirium after hip fracture: A randomised trial. Journal of the American Geriatric Society 2001; 49: 516–522.
- 31 Inouye SK, Bogardus T, Williams CS, Leo-Summers L, Agostini JV. The role of adherence on the effectiveness of nonpharmacologic interventions: Evidence from the delirium prevention trial. Archives of Internal Medicine 2003; 163: 958–964.
- 32 Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: A systematic review of the effect of continuing medical education strategies. Journal of the American Medical Association 1995; 274: 700–705.
- 33 Heffner JE. Altering physician behaviour to improve clinical performance. Topics in Health Information Management 2001; 22: 1–9.
- 34 Grimshaw JM, Thomas RE, MacLennan G et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment Report 2004; 8: 1–72.
- 35 Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. Canadian Medical Association Journal 1995; 153: 1423–1431.
- 36 Forsetlund L, Bjorndal A, Rashidian A et al. Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2009; Issue 2. Art. No.: CD003030 DOI: 10.1002/14651858.CD003030.pub2.
- 37 Tropea J, Slee J-A, Brand CA, Gray L, Snell T. Clinical practice guidelines for the management of delirium in older people. Australasian Journal on Ageing 2008; 27: 150–156.
- 38 National Clinical Guidelines Centre. Delirium: diagnosis, prevention and management. London: National Clinical Guidelines Centre at the Royal College of Physicians, July 2010. [Cited 5 January 2011.] Available from URL: http://www.nice.org.uk/nicemedia/live/13060/49908/49908.pdf
- 39 British Geriatrics Society and Royal College of Physicians. Guidelines for the Prevention, Diagnosis and Management of Delirium in Older People. Concise guidance to good practice series, No. 6. London: RCP, 2006.
- 40 Gill G. Going Dutch? How to make clinical guidelines work: An innovative report from Holland. Clinical Medicine 2001; 1: 307–308.
- 41 Davis DA, Taylor-Vaisey A. Translating guidelines into practice. Canadian Medical Association 1997; 157: 408–416.
- 42 Davis D, O'Brien MA, Freemantle N et al. Impact of formal continuing medical education. Do conferences, workshops, rounds and other traditional continuing education activities change physician behaviour or health outcomes. Journal of the American Medical Association 1999; 282: 867–874.
- 43 Tabet N, Howard R. Non-pharmacological interventions in the prevention of delirium. Age and Ageing 2009; 38: 374–379.
- 44 Rockwood K, Cosway S, Stolee P et al. Increasing the recognition of delirium in elderly patients. Journal of the American Geriatrics Society 1994; 42: 252–256.
- 45 Milisen K, Lemiengre J, Braes T, Foreman MD. Multicomponent intervention strategies for managing delirium in hospitalised older people: Systematic review. Journal of Advanced Nursing 2005; 52: 79–90.
- 46 Holmes J. Delirium: A clarion call. International Review of Psychiatry 2009; 21: 4–7.
- 47 Teodorczuk A, Welfare M, Corbett S, Mukaetova-Ladinska E. Developing effective educational approaches for Liaison Old Age Psychiatry teams: A literature review of the learning needs of hospital staffing relation to managing the confused older patient. International Psychogeriatrics 2009; 1–12.
- 48 Kirkpatrick DL. Evaluating Training Programs: The Four Levels. San Francisco, CA: Berret-Koehler, 1994.
- 49 Rizzo JA, Bogardus ST, Leo-Summers L et al. Multicomponent targeted intervention to prevent delirium in hospitalised older patients: What is the economic value? Medical Care 2001; 39: 740–752.
- 50 Bagri AS, Flacker JM. Care of the hospitalised aging medical patient: Delirium module. Journal of the American Geriatrics Society 2009; 57: 1268–1269.
- 51 Irving K, Detroyer E, Foreman M, Milisen K. The virtual gateway: Opening doors in delirium teaching and learning. International Review of Psychiatry 2009; 21: 15–19.