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

Catriona Jackson, Catherine Malia, Hannah Zacharias, Judith Dyson (Corresponding / Lead Author), Miriam Johnson

    Research output: Contribution to journalArticlepeer-review

    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
    Original languageEnglish
    JournalPLoS ONE
    DOIs
    Publication statusPublished (VoR) - 26 Sept 2024

    Keywords

    • Delirium
    • Quality Improvement
    • Hospice
    • Palliative Care
    • Barriers

    Fingerprint

    Dive into the research topics of 'Improving hospice delirium guideline adoption through an understanding of barriers and facilitators: A mixed-methods co-design study'. Together they form a unique fingerprint.

    Cite this