Delirium screening in patients in a palliative care ward: a best practice implementation project. 2019

Xiao Bin Lai, and Zhe Huang, and Chun Yan Chen, and Matthew Stephenson
School of Nursing, Fudan University, Shanghai, China.

The objective was to promote evidence-based practice in screening for delirium in patients in the palliative care ward of a cancer hospital in Shanghai. Delirium is common but under recognized among patients in palliative care settings. Early detection is essential for timely management. Practice guidelines recommend an initial screening at first contact, followed by continuous screening. The Joanna Briggs Institute's three-phase Practical Application of Clinical Evidence System and the Getting Research into Practice audit and feedback tool were used to enhance evidence-based practice. In phase 1, four audit criteria were developed and a baseline audit was conducted. In phase 2, barriers to compliance were identified, and strategies were adopted to promote best practice. In phase 3, a follow-up audit was conducted. In the baseline audit, no delirium screening was performed, either on admission or regularly during hospitalization, hence compliance with these two audit criteria was 0%. Two out of 18 nurses had received training in delirium management, however neither had been trained to use the delirium screening tool. Compliance with the two criteria for nurse training was 11% and 0%, respectively. Four barriers were identified, including lack of a standardized screening tool, lack of a standardized screening procedure, inadequate knowledge on the part of the nurses, and potential inconsistencies between nurses in the rating of screening criteria. After applying strategies to address these barriers, compliance with the four audit criteria was 100%, 100%, 72%, and 72%, respectively, in the follow-up audit. Best practice in delirium screening was successfully established in the ward.

UI MeSH Term Description Entries
D008403 Mass Screening Organized periodic procedures performed on large groups of people for the purpose of detecting disease. Screening,Mass Screenings,Screening, Mass,Screenings,Screenings, Mass
D009726 Nurses Professionals qualified by graduation from an accredited school of nursing and by passage of a national licensing examination to practice nursing. They provide services to patients requiring assistance in recovering or maintaining their physical or mental health. Nursing Personnel,Personnel, Nursing,Registered Nurses,Nurse,Nurse, Registered,Nurses, Registered,Registered Nurse
D010166 Palliative Care Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed) Palliative Treatment,Palliative Supportive Care,Palliative Surgery,Palliative Therapy,Surgery, Palliative,Therapy, Palliative,Care, Palliative,Palliative Treatments,Supportive Care, Palliative,Treatment, Palliative,Treatments, Palliative
D010362 Patients' Rooms Rooms occupied by one or more individuals during a stay in a health facility. The concept includes aspects of environment, design, care, or economics. Private Rooms,Rooms, Patient,Semi-Private Rooms,Wards, General,General Ward,General Wards,Patient Room,Patient Rooms,Patient's Rooms,Patients Rooms,Patients' Room,Private Room,Room, Patient,Room, Patients',Room, Private,Room, Semi-Private,Rooms, Patients',Rooms, Private,Rooms, Semi-Private,Semi Private Rooms,Semi-Private Room,Ward, General
D003693 Delirium A disorder characterized by CONFUSION; inattentiveness; disorientation; ILLUSIONS; HALLUCINATIONS; agitation; and in some instances autonomic nervous system overactivity. It may result from toxic/metabolic conditions or structural brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2) Delirium of Mixed Origin,Subacute Delirium,Delirium, Subacute,Deliriums, Subacute,Mixed Origin Delirium,Mixed Origin Deliriums,Subacute Deliriums
D004506 Education, Nursing Use for general articles concerning nursing education. Nursing Education,Educations, Nursing,Nursing Educations
D006760 Hospitalization The confinement of a patient in a hospital. Hospitalizations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D017410 Practice Guidelines as Topic Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. Clinical Guidelines as Topic,Best Practices,Best Practice
D042241 Early Diagnosis Methods to determine in patients the nature of a disease or disorder at its early stage of progression. Generally, early diagnosis improves PROGNOSIS and TREATMENT OUTCOME. Early Detection of Disease,Diagnosis, Early,Disease Early Detection

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