Zoran Trogrlić1, Erwin Ista2, Huibert H Ponssen3, Jeannette F Schoonderbeek4, Frodo Schreiner5, Serge J Verbrugge6, Annemieke Dijkstra7, Jan Bakker1, Mathieu van der Jagt1. 1. Department of Intensive Care, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands. 2. Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, the Netherlands. 3. Department of Intensive Care, Albert Schweitzer Hospital, Dordrecht, the Netherlands. 4. Department of Intensive Care, Ikazia Hospital, Rotterdam, the Netherlands. 5. Department of Intensive Care, IJsselland Hospital, Rotterdam, the Netherlands. 6. Department of Intensive Care, Sint Franciscus Gasthuis, Rotterdam, the Netherlands. 7. Department of Intensive Care, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
Abstract
BACKGROUND: Delirium is a common form of vital organ dysfunction in intensive care unit (ICU) patients and is associated with poor outcomes. Adherence to guideline recommendations pertaining to delirium is still suboptimal. AIMS: We performed a survey aimed at identifying barriers for implementation that should be addressed in a tailored implementation intervention targeted at improved ICU delirium guideline adherence. DESIGN: The survey was conducted among ICU professionals. METHODS: An online survey was conducted among 360 ICU health care professionals (nurses, physicians and delirium consultants) from six ICUs in the southwest of the Netherlands as part of a multicentre prospective implementation project [response rate: 64% of 565 invited; 283 (79%) were nurses]. RESULTS: Although the majority (83%) of respondents considered delirium a common and major problem in the ICU, we identified several barriers for implementation of a delirium guideline. The most important barriers were knowledge deficit, low delirium screening rate, lack of trust in the reliability of delirium screening tools, belief that delirium is not preventable, low familiarity with delirium guidelines, low satisfaction with physician-described delirium management, poor collaboration between nurses and physicians, reluctance to change delirium care practices, lack of time, disbelief that patients would receive optimal care when adhering to the guideline and the perception that the delirium guideline is cumbersome or inconvenient in daily practice. CONCLUSION: Although ICU professionals consider delirium a serious problem, several important barriers to adhere to guidelines on delirium management are still present today. RELEVANCE TO CLINICAL PRACTICE: Identification of implementation barriers for adherence to guidelines pertaining to delirium is feasible with a survey. Results of this study may help to design-targeted implementation strategies for ICU delirium management.
BACKGROUND:Delirium is a common form of vital organ dysfunction in intensive care unit (ICU) patients and is associated with poor outcomes. Adherence to guideline recommendations pertaining to delirium is still suboptimal. AIMS: We performed a survey aimed at identifying barriers for implementation that should be addressed in a tailored implementation intervention targeted at improved ICU delirium guideline adherence. DESIGN: The survey was conducted among ICU professionals. METHODS: An online survey was conducted among 360 ICU health care professionals (nurses, physicians and delirium consultants) from six ICUs in the southwest of the Netherlands as part of a multicentre prospective implementation project [response rate: 64% of 565 invited; 283 (79%) were nurses]. RESULTS: Although the majority (83%) of respondents considered delirium a common and major problem in the ICU, we identified several barriers for implementation of a delirium guideline. The most important barriers were knowledge deficit, low delirium screening rate, lack of trust in the reliability of delirium screening tools, belief that delirium is not preventable, low familiarity with delirium guidelines, low satisfaction with physician-described delirium management, poor collaboration between nurses and physicians, reluctance to change delirium care practices, lack of time, disbelief that patients would receive optimal care when adhering to the guideline and the perception that the delirium guideline is cumbersome or inconvenient in daily practice. CONCLUSION: Although ICU professionals consider delirium a serious problem, several important barriers to adhere to guidelines on delirium management are still present today. RELEVANCE TO CLINICAL PRACTICE: Identification of implementation barriers for adherence to guidelines pertaining to delirium is feasible with a survey. Results of this study may help to design-targeted implementation strategies for ICU delirium management.
Authors: Sharon K Inouye; Michael Simon Avidan; Hannah R Maybrier; Angela M Mickle; Krisztina E Escallier; Nan Lin; Eva M Schmitt; Ravi T Upadhyayula; Troy S Wildes; George A Mashour; Kerry Palihnich Journal: BMJ Open Date: 2018-11-21 Impact factor: 2.692
Authors: Zoran Trogrlic; Mathieu van der Jagt; Theo van Achterberg; Huibert Ponssen; Jeannette Schoonderbeek; Frodo Schreiner; Serge Verbrugge; Annemieke Dijkstra; Jan Bakker; Erwin Ista Journal: BMJ Open Qual Date: 2020-09
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