Delirium Superimposed on Dementia Clinical Trial
Official title:
Early Nurse Detection of Delirium Superimposed on Dementia
Delirium (acute confusion) is common and costly in persons with dementia, resulting in longer hospital stays, more complications, and greater functional decline. This research tests the use of the electronic health record, education, and regular feedback to nurses to improve detection and management of delirium. Ultimately, findings will direct ways to improve acute care of this vulnerable population.
Delirium is an acute, reversible change in mental status that occurs in over 40% of persons
with dementia. Delirium superimposed on dementia (DSD) leads to increased mortality,
increased costs, nursing home placement, early re-hospitalization, and functional decline.
Delirium in persons with dementia appears to substantially worsen outcomes in persons with
dementia- who are already burdened with functional decline. The purpose of this study is to
improve nursing detection and management of delirium in persons with dementia and decrease
the duration and patient complications of delirium. To achieve these objectives, a
multi-component intervention strategy called, Early Nurse Detection of Delirium Superimposed
on Dementia (END DSD) will be tested. END-DSD employs a paired cluster randomized trial
(C-RCT) of three hospitals with a total of six inpatient units and 360 hospitalized persons
with dementia to achieve these objectives. END DSD intervention consists of 1) Nursing
education regarding DSD, 2) Computerized decision support through standardized delirium
assessment and management screens via the electronic health record (EHR), 3) an identified
unit champion on each intervention unit who will be utilized to persuade other nurses to
implement the innovation, and 4) Weekly feedback to the nursing staff to further facilitate
assessment and management of delirium. We are testing the following specific aims: A.1: To
determine whether the intervention "END DSD" improves nurse detection and management of DSD.
A.2: To determine the effect of "END DSD" intervention on patient clinical outcomes,
including duration of delirium and rate of psychoactive medications.
The study focuses on a costly and prevalent problem, and utilizes a novel approach that via
the EHR will clearly be replicable across settings of care. END-DSD has the potential to
significantly improve quality of life and decrease costs of care by: improving the detection
of DSD; increasing the use of non-pharmacological management of DSD; shortening the duration
of delirium and hospital length of stay; and decreasing the use of inappropriate medications,
thus mitigating the complications of DSD. This project builds on over a decade of funded
research and clinical practice by the investigators, and brings their unique and
collaborative efforts together in an innovative manner to impact the under addressed problem
of DSD in hospitalized older adults.
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