Authors (including presenting author) :
Lau KW(1), Li LY(1), Ching WK(1)
Affiliation :
(1)Department of Occupational Therapy, North District Hospital
Introduction :
Patients with acute hip fracture are vulnerable to delirium. Patients experiencing delirium would have higher risk of adverse outcomes. International guidelines recommend evidence-based practices for delirium prevention including risks stratification by early detections and Multicomponent Intervention Package (MIP). This hospital based quality service improvement project aims to explore the applicability of the recommended early detection and MIP intervention to elderly patients with hip fracture who are at risk of delirium.
Objectives :
To investigate the applicability of the Perioperative Delirium Management program in terms of (1) adherence to protocol, (2) staff’s acceptability, and (3) the cost-benefit.
Methodology :
Quasi-experimental design. The delirium management program was delivered to intervention group. Patient’s delirium risks were assessed and stratified according to the recommended guidelines. Corresponding individualized interventions (MIP) were provided. Control group received standard of care. Subjects: hospitalized patients aged 65 or above with hip fracture. Measures: (1) use checklist to review the compliance to protocol, (2) staff competency on implementation, and (3) time spent on intervention.
Result & Outcome :
From April 2021 to December 2022, 176 patients with hip fracture were recruited. 72 (41%) patients were allocated to intervention group according to existing daily operation. With protocol-driven detection procedure, 7 out of 72 patients were identified as suspicious delirium with an incidence rate of 9.7%. Outcome: (1) High compliance of the pathway (93%). (2) Staff reported increased confidence (87%); enhanced knowledge in delirium care (87%); and agreed the protocol was practicable (93%). (3) Administration time of detection was on average 1 minute. Average 15-30 minutes were spent on providing MIP to suspicious delirium. The average 14.81 days length of stay in intervention group showed no significant difference (p=0.846) to control group (n=104). Conclusion The piloted program, characterized by structured program, early detection and stratified evidence-based practice was deemed practicable. The benefits outweighed the time spent on implementation and the program did not lengthen the hospitalization. This program could also enhance awareness and knowledge of healthcare workers in ward in detecting and managing patients with delirium. Thus, it could potentially reduce care-related injury while handling confused patients. Further study and expanded application to different patient groups at risk of delirium is indicated.
