Improving hospice delirium guideline adoption through an understanding of barriers and facilitators: A mixed-methods co-design study

Jackson, Catriona and Malia, Catherine and Zacharias, Hannah and Dyson, Judith and Johnson, Miriam (2024) Improving hospice delirium guideline adoption through an understanding of barriers and facilitators: A mixed-methods co-design study. PLOS ONE. ISSN 1932-6203

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Abstract

Objectives
This study seeks to understand and address barriers to practitioners’ optimal assessment and management of people with delirium in hospices.
Methods
Retrospective clinical record review to identify areas of low concordance with guideline-adherent delirium care, followed by a survey of healthcare practitioners to identify barriers and facilitators to optimal care. Qualitative interviews with health care practitioners to explore and develop strategies to address barriers or optimise facilitators and a meeting with senior clinical staff to refine identified strategies.
Results
Eighty clinical records were reviewed. Elements of poor guideline concordance were identified. Delirium screening on admission was conducted for 61% of admissions. Non-pharmacological management was documented for 59% of those we identified as having delirium from the clinical records. Survey and interview data identified key barriers to delirium assessment as competing priorities, poor knowledge and skills and lack of environmental resources (staff and guidelines, environment). A co-design process resulted in strategies to address barriers and enhance facilitators including champions, educational meetings, audit and feedback, and environmental changes (including careful consideration of the staff skills mix on shift and tools to support non-pharmacological management). 
Conclusions
Implementation of strategies should result in greater guideline-adherent delirium care. Further work should test this in practice and include both process and clinical outcomes (e.g., reduction in delirium days). We conducted a theoretically underpinned, internationally relevant study in a hospice in England, UK

Item Type: Article
Identification Number: 10.1371/journal.pone.0310704
Dates:
Date
Event
6 September 2024
Accepted
26 September 2024
Published Online
Uncontrolled Keywords: Delirium, Quality Improvement, Hospice, Palliative Care, Barriers
Subjects: CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-02 - medicine (non-specific)
CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-01 - nursing (non-specific)
Divisions: Faculty of Health, Education and Life Sciences > College of Nursing and Midwifery
Depositing User: Judith Dyson
Date Deposited: 12 Sep 2024 12:29
Last Modified: 02 Oct 2024 15:07
URI: https://www.open-access.bcu.ac.uk/id/eprint/15806

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