TY - JOUR
T1 - Implementing a Rapid, Two-Step Delirium Screening Protocol in Acute Care
T2 - Barriers and Facilitators
AU - Husser, Erica K.
AU - Fick, Donna M.
AU - Boltz, Marie
AU - Shrestha, Priyanka
AU - Siuta, Jonathan
AU - Malloy, Shannon
AU - Overstreet, Abigail
AU - Leslie, Douglas L.
AU - Ngo, Long
AU - Jung, Yoojin
AU - Inouye, Sharon K.
AU - Marcantonio, Edward R.
N1 - Funding Information:
The authors would like to thank Janice Penrod for sharing her methodological expertise, providing theoretical guidance, and for training field researchers on techniques of focused ethnography. This work was supported by the National Institute on Aging (R01AG030618 to D.M.F. and E.R.M., K24AG035075 to E.R.M., R01AG044518 to S.K.I., R24AG054259 to S.K.I., P01AG031720 to S.K.I.), and the National Institute of Nursing Research (R01NR01104 to D.M.F.).
Publisher Copyright:
© 2021 The American Geriatrics Society
PY - 2021/5
Y1 - 2021/5
N2 - BACKGROUND/OBJECTIVES: An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+). DESIGN: A qualitative descriptive design using observational data collection and brief semi-structured interviews. SETTINGS: An urban academic medical center and a community teaching hospital. PARTICIPANTS: Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs). MEASUREMENTS: Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations. RESULTS: The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening. CONCLUSION: This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
AB - BACKGROUND/OBJECTIVES: An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+). DESIGN: A qualitative descriptive design using observational data collection and brief semi-structured interviews. SETTINGS: An urban academic medical center and a community teaching hospital. PARTICIPANTS: Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs). MEASUREMENTS: Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations. RESULTS: The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening. CONCLUSION: This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
UR - http://www.scopus.com/inward/record.url?scp=85100177372&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100177372&partnerID=8YFLogxK
U2 - 10.1111/jgs.17026
DO - 10.1111/jgs.17026
M3 - Article
C2 - 33474729
AN - SCOPUS:85100177372
SN - 0002-8614
VL - 69
SP - 1349
EP - 1356
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 5
ER -