Susan Freter1,2, Katalin Koller1,2, Michael Dunbar3,4, Chris MacKnight1,2, Kenneth Rockwood1,2. 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.
RCT Entities:
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.
Authors: Sankar D Navaneethan; Stacey E Jolly; Jesse D Schold; Susana Arrigain; Georges Nakhoul; Victoria Konig; Jennifer Hyland; Yvette K Burrucker; Priscilla Davis Dann; Barbara H Tucky; John Sharp; Joseph V Nally Journal: Clin J Am Soc Nephrol Date: 2017-08-04 Impact factor: 8.237
Authors: Sara C LaHue; Vanja C Douglas; Teresa Kuo; Carol A Conell; Vincent X Liu; S Andrew Josephson; Clay Angel; Kristen B Brooks Journal: J Hosp Med Date: 2019-04 Impact factor: 2.960
Authors: K J Sheehan; E M Guerrero; D Tainter; B Dial; R Milton-Cole; J A Blair; J Alexander; P Swamy; L Kuramoto; P Guy; J P Bettger; B Sobolev Journal: Osteoporos Int Date: 2019-04-29 Impact factor: 4.507
Authors: Giuseppe Bellelli; Alessandro Morandi; Marco Trabucchi; Guido Caironi; Daniele Coen; Carlo Fraticelli; Ciro Paolillo; Carolina Prevaldi; Angela Riccardi; Gianfranco Cervellin; Corrado Carabellese; Salvatore Putignano; Stefania Maggi; Antonio Cherubini; Paola Gnerre; Andrea Fontanella; Nicola Latronico; Concezione Tommasino; Antonio Corcione; Giovanni Ricevuti; Nicola Ferrara; Francesco De Filippi; Alberto Ferrari; Mario Guarino; Maria Pia Ruggieri; Pietro Amedeo Modesti; Carlo Locatelli; Patrizia Hrelia; Marco Otto Toscano; Emi Bondi; Antonio Tarasconi; Luca Ansaloni; Francesco Perticone Journal: Intern Emerg Med Date: 2017-07-24 Impact factor: 3.397
Authors: Heidi Lindroth; Lisa Bratzke; Sara Twadell; Paul Rowley; Janie Kildow; Mara Danner; Lily Turner; Brandon Hernandez; Roger Brown; Robert D Sanders Journal: Int J Geriatr Psychiatry Date: 2019-04-23 Impact factor: 3.485
Authors: Jennifer K Burton; Louise Craig; Shun Qi Yong; Najma Siddiqi; Elizabeth A Teale; Rebecca Woodhouse; Amanda J Barugh; Alison M Shepherd; Alan Brunton; Suzanne C Freeman; Alex J Sutton; Terry J Quinn Journal: Cochrane Database Syst Rev Date: 2021-11-26
Authors: Heather L Neville; Mia Losier; Jennifer Pitman; Melissa Gehrig; Jennifer E Isenor; Laura V Minard; Ellen Penny; Susan K Bowles Journal: Can J Hosp Pharm Date: 2020-06-01
Authors: Toby O Smith; Anthony W Gilbert; Ashwini Sreekanta; Opinder Sahota; Xavier L Griffin; Jane L Cross; Chris Fox; Sarah E Lamb Journal: Cochrane Database Syst Rev Date: 2020-02-07
Authors: Jennifer K Burton; Louise E Craig; Shun Qi Yong; Najma Siddiqi; Elizabeth A Teale; Rebecca Woodhouse; Amanda J Barugh; Alison M Shepherd; Alan Brunton; Suzanne C Freeman; Alex J Sutton; Terry J Quinn Journal: Cochrane Database Syst Rev Date: 2021-07-19