Early Nurse Detection and Management of Delirium (END-DSD)
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.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:||Early Nurse Detection of Delirium Superimposed on Dementia|
- Severity of Delirium [ Time Frame: Participants will be assessed daily until discharge (duration of hospitalization), which is expected to be about 5 days ] [ Designated as safety issue: No ]Measured using the Delirium Rating Scale R-98.
- Inappropriate CNS-Active Medication Use [ Time Frame: Participants will be assessed daily until discharge (duration of hospitalization), which is expected to be about 5 days ] [ Designated as safety issue: No ]Ascertained from patient's medical record
- Nurse Detection of Delirium [ Time Frame: Participants will be assessed every shift until discharge (duration of hospitalization), which is expected to be about 5 days ] [ Designated as safety issue: No ]Ascertained through electronic health record and chart review
- Delirium Duration [ Time Frame: Participants will be assessed daily until discharge (duration of hospitalization), which is expected to be about 5 days ] [ Designated as safety issue: No ]Measured using the Confusion Assessment Method (CAM)
|Study Start Date:||April 2010|
|Estimated Study Completion Date:||February 2015|
|Primary Completion Date:||February 2014 (Final data collection date for primary outcome measure)|
|Experimental: END-DSD Intervention||
Multi-component intervention including 1) Nursing education regarding detection and management of delirium superimposed on dementia; 2) Computerized decision support and EHR; 3) A unit champion nurse for promotion of delirium assessment and management; 4) Feedback to nursing staff
|No Intervention: Control|
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.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01505257
|United States, Pennsylvania|
|Mount Nittany Medical Center|
|State College, Pennsylvania, United States, 16801|
|United States, Tennessee|
|Vanderbilt University Medical Center|
|Nashville, Tennessee, United States|
|Principal Investigator:||Donna Fick, RN,PhD||Penn State University|
|Study Chair:||Lorraine Mion, RN,PhD||Vanderbilt University|
|Study Director:||Jane McDowell, MSN||Penn State University|
|Study Chair:||Sharon Inouye, MD, MPH||Harvard University|
|Study Chair:||Ann Kolanowski, RN,PhD,FAAN||Penn State University|