Delirium Clinical Trial
Official title:
Pilot Study of a Multicomponent Nurse Intervention to Reduce the Incidence and Severity of Delirium in Hospitalized Older Adults: MID-Nurse-P
Objectives: To analyze if a multicomponent nurse-led intervention randomized clinical trial
(MID-Nurse Study) is feasible (Pilot study), and can reduce the incidence, duration, and
severity of delirium in hospitalized older adults in an AGU.
Design: Parallel-group Double-blind Randomized Clinical Trial (Pilot Study). Setting: AGU
"Complejo Hospitalario Universitario from Albacete" (Albacete, Spain).
Participants: 50 patients ≥ 65 years hospitalized in the AGU (21 intervention group, 29
control group).
Interventions: After risk factor analysis, all participants in the intervention group (IG)
received a daily multicomponent intervention (orientation, sensorial deficit, sleep,
mobilization, hydration, nutrition, drugs, elimination, oxygenation, pain) by the
intervention nurses. The control group (CG) received usual care.
Measurements: Delirium presence was determined daily with the Confusion Assessment Method
(CAM), and delirium severity with the Delirium Rating Scale-Revised-98 (DRS). Mortality,
days of hospitalization, use of physical restraint measures, and use of drugs for delirium
control (neuroleptics and benzodiacepines) were also recorded.
Parallel-group, double blind (evaluation and analysis), randomized clinical trial (pilot
study). The design was based on recommendations for conducting pilot studies (Thabane 2010).
The main objective of the MID-Nurse (Randomized Clinical Trial) was to analyze if a
multicomponent nurse-led intervention reduces the incidence, duration, and severity of
delirium in hospitalized older adults in an Acute Geriatric Unit (AGU).
Specific objectives and evaluating criteria of the MID-Nurse-P (Pilot Study) were:
- Process: To determine the recruitment rate (criteria: at least 70% of the eligible
patients can be recruited), the complete follow-up rate (criteria: at least 85% of the
included participants complete the follow-up), and the adherence to intervention
(criteria: at least 80% of the included participants receive every scheduled
intervention).
- Resources: To assess capacity of the team and process time to conduct the trial.
Criteria: Less than 10% of the participants can´t complete the intervention program due
to study team problems, and daily time employed per participant is not longer than 30
minutes.
- Management: To analyze potential study personnel and data managing problems.
- Scientific: To estimate the intervention effect and the variance.
In the first 24 hours from admission, all the following data were collected by the
evaluation nurses, once the informed consent was signed, and randomization performed by the
principal investigator, who did not take part in the rest of the data collection and
clinical intervention: Demographic data, Charlson comorbidity index, mean clinical diagnosis
for admission, usually consumed drugs before admission, Barthel index, Holden´s FAC
instrument, Pfeiffer´s Short Portable Mental Status Questionnaire, Reisberg´s Global
Deterioration Scale, Dowton scale, pain with the visual analogical scale, and pressure
ulcers risk with the Braden scale. Vital signs were determined on admission, including blood
pressure, heart rate, temperature, hydration level, and oxygen saturation. Medical or nurse
procedures were recorded, including bladder catheterization, nasogastric tube placement,
venous or arterial access, blood sample acquisition, and other invasive procedures.
Blood sample was collected, and haemoglobin, leukocyte and neutrophil count, reactive C
protein, sedimentation rate, glucose, urea, sodium, potassium, albumin, total proteins,
cholesterol, thyroid stimulating hormone, transferrin, ferritin, total iron, folic acid, and
B12 vitamin, were recorded.
After patient enrollment, all the patients received daily an evaluation of the Confusion
Assessment Method scale (CAM) (Inouye 1990) by the evaluation nurses, in the afternoon.
Prevalence of delirium throughout the follow-up was described, prevalence excluding the
first day (to avoid bias of patients that were admitted with confusion), and incidence of
delirium (new case across the follow-up, one patient could have more than 1 incident
delirium). Number of days with delirium were also registered, and mean number of days with
delirium was calculated for both groups.
In the case that the CAM was positive for delirium, patients also were evaluated with the
Delirium Rating Scale-Revised-98 (DRS-R-98) (de Rooij 2006) to determine delirium severity.
Total delirium severity was calculated by adding the severity of delirium during all days of
hospitalization, and mean severity per day was calculated dividing the global severity per
number of days with delirium.
Main outcome variables were the presence of delirium throughout the follow-up (dichotomic
variable, yes/no), number of days with delirium during hospitalization (continuous
variable), and total delirium severity (sum of DRS-R-98 during the complete follow-up).
Participants in the intervention group received the first intervention in the first 24 hours
from admission, and thereafter daily until hospital discharge. Participants in the control
group received usual medical and nurse care during all the hospitalization process. The
intervention was carried out exclusively by the "intervention nurses", and was composed of
two main parts, being the first one a risk factor analysis, and the second one the
intervention on the risk factors detected (orientation, sensorial deficit, sleep,
mobilization, hydration, nutrition, drugs, elimination, oxygenation, pain). Furthermore, the
intervention nurses identified the principal caregiver in the first 24 hours from admission,
and provided an informative booklet about strategies and recommendations to prevent delirium
incidence, including ambient strategies, orientation abilities, and identification of alert
signs.
;
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Investigator, Outcomes Assessor), Primary Purpose: Prevention
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