{"corpus_id":231758694,"paper_sha":"6ef05089514b0e5916633e4ad315482ce6c77daa","doi":"10.1136/bmjoq-2020-001186","arxiv_id":null,"pmid":33526446,"pmcid":"PMC7853031","mag_id":null,"dblp_id":null,"acl_id":null,"title":"Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project","year":2021,"publication_date":"2021-01-01","venue":"BMJ Open Quality","journal":{"name":"BMJ Open Quality","pages":null,"volume":"10"},"journal_issn":null,"journal_title":null,"publication_types":["JournalArticle"],"pubmed_pub_types":["Journal Article","Research Support, Non-U.S. Gov't"],"s2_fields_of_study":["Medicine"],"reference_count":33,"citation_count":4,"influential_citation_count":0,"is_open_access":true,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Aged","mj":false,"ui":"D000368"},{"d":"Delirium","mj":true,"qs":[{"q":"epidemiology","mj":false,"ui":"Q000453"},{"q":"prevention & control","mj":false,"ui":"Q000517"}],"ui":"D003693"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Inpatients","mj":false,"ui":"D007297"},{"d":"Orthopedics","mj":true,"ui":"D009985"},{"d":"Quality Improvement","mj":false,"ui":"D058996"}],"chemicals":null,"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":"https://bmjopenquality.bmj.com/content/bmjqir/10/1/e001186.full.pdf","s2_open_access_landing_url":"https://www.semanticscholar.org/paper/6ef05089514b0e5916633e4ad315482ce6c77daa","s2_open_access_license":"CCBYNC","s2_open_access_status":"GOLD","pmc_open_access_pdf_url":"https://pmc-oa-opendata.s3.amazonaws.com/PMC7853031.1/PMC7853031.1.pdf","pmc_open_access_landing_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7853031/","pmc_open_access_license":"CC BY-NC","pmc_open_access_status":"open_access_subset","unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one of the most common postoperative complications in older adults undergoing orthopaedic surgery. Multicomponent, non-pharmacological interventions can reduce delirium incidence by up to 30% but are often challenging to implement as part of routine care. We identified a gap in the delivery of non-pharmacological interventions on an orthopaedic unit. This project aimed to implement a bedside sign on an orthopaedic unit to reduce the occurrence of delirium by prompting staff to use multicomponent evidence-based delirium prevention strategies for at-risk older adults. Quality improvement methods were used to integrate and optimise the use of a bedside ‘delirium prevention’ sign on an orthopaedic unit. The sign was implemented in four target rooms and sign completion rates increased from 47% to 83% (95% CI 71.7% to 94.9%; p<0.001) over a 10-month period. The sign did not have a significant impact on delirium prevalence. The mean Confusion Assessment Method (CAM)+ rate during the baseline period was 8% with an absolute increase in the intervention period to 11.4% (95% CI 7.2% to 15.8%; p=0.31). There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.","claims":[{"public_id":"cl_3b844cd1ab212c20b3a49c70da0218cd","status":"active","text":"A low-cost, feasible, evidence-based bedside sign was successfully integrated into routine clinical care to support delivery of delirium prevention strategies.","confidence":0.93,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_3b844cd1ab212c20b3a49c70da0218cd"},{"public_id":"cl_504b51050abef4f8f0826ab001b32e69","status":"active","text":"Bedside delirium prevention sign completion rates increased from 47% to 83% over 10 months after implementation on the orthopaedic 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