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J Am Geriatr Soc. 2017 Mar;65(3):567-573. doi: 10.1111/jgs.14568. Epub 2016 Nov 22.

Translating Delirium Prevention Strategies for Elderly Adults with Hip Fracture into Routine Clinical Care: A Pragmatic Clinical Trial.

Author information

1
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
2
Center for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Halifax, Nova Scotia, Canada.
3
Division of Orthopedics, Department of Surgery, School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada.
4
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

OBJECTIVES:

To compare the feasibility (adherence) and effectiveness (prevalence of delirium, length of stay, mortality, discharge site) of delirium-friendly preprinted postoperative orders (PPOs) for individuals with hip fracture, administered by regular orthopedic nurses, with routine postoperative orders.

DESIGN:

Pragmatic clinical trial to evaluate a quality improvement intervention.

SETTING:

Tertiary care hospital.

PARTICIPANTS:

Individuals aged 65 and older admitted for hip fracture repair (N = 283).

INTERVENTION:

PPOs with delirium-friendly options and doses for nighttime sedation, analgesia, and nausea and attention to catheter removal and bowel movements.

MEASUREMENTS:

Adherence to PPO was compared with adherence to routine orders. Drug doses were recorded. Presence of delirium was documented using the Confusion Assessment Method and the Mini-Mental State Examination on postoperative Days 1, 3, and 5. Length of stay, discharge site, and in-hospital mortality were recorded.

RESULTS:

Orthopedic nurses adhered reasonably well with delirium-friendly PPOs. Of 283 participants, 42% developed postoperative delirium, with significantly less delirium in the intervention group (intervention 33%, control 51%, P = .001). The effect of the intervention was stronger in individuals with preexisting dementia (intervention 60%, control 97%, P < .001). Participants with postoperative delirium had longer hospital stays and were more likely to die or be discharged to a nursing home, but there was no significant between-group difference in these outcomes.

CONCLUSION:

It is possible to introduce delirium-friendly PPOs into routine post-hip fracture care in a representative elderly population including individuals with dementia. Delirium-friendly PPOs executed by regular nursing staff resulted in a significant reduction in postoperative delirium but no difference in other outcomes.

KEYWORDS:

delirium; dementia; hip fracture; knowledge translation

PMID:
27874185
DOI:
10.1111/jgs.14568
[Indexed for MEDLINE]

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