Table 1 Overview of content of modules and implementation resources for the unit interprofessional delirium guideline
Title of Module | Format (Approximate Duration) | Intended Audience | Notes |
Introductory interprofessional module: ‘The Starter Kit’ | Mandatory face-to-face training session (IP presenters from the guideline adaptation group) (45 min) | All healthcare team (including ward clerks, porters) and volunteers | - Designed as fundamental ‘core’ delirium education and also to orientate learners to the content of the guideline and subsequent e-Learning modules - Describes features of delirium, and terminology used - Provides brief contrast of delirium screening tools used by different members of the IP team: Nu-DESC [32] (used by nurses only), CAM [40] (used by physicians only), and SQiD [41] (new tool for PCU: introduced in order to be used by other members of IP team, PCU staff and volunteers) - Gives outline of non-pharmacological interventions (All attendees given copy of patient/family delirium information leaflet) |
Evaluation and monitoring a delirious patient | Mandatory face-to-face training session, at end of ‘Starter Kit’ session (NPL/ PSN presenters) (15 min) | Nurses only | - Linked with our organisation’s Nursing “Always Practices”, i.e. Bedside shift report; hourly rounding; update patient care boards; start/end of shift assessments; safety huddle; and priority lists |
Nurse-driven delirium screening on the PCU | e-Learning module (15 min) | Nurses only | - To review the Nu-DESC tool (a paper version of the tool had been in use on our PCU for many years before this project started but the Nu-DESC had recently been embedded within the EPR as standardised PCU documentation for nursing at the end of each 8-h shift) - Provides detailed information on how to rate the 5 Nu-DESC observed symptoms - Includes 2 case studies (hyperactive vs. hypoactive delirium) for nurses to rate the Nu-DESC and compare results with peers |
Delirium care tips: Non-pharmacological strategies for delirium management on the PCU | e-Learning module (with voiceover) (10 min) | All healthcare team (including ward clerks, and porter) | - Multicomponent interventions derived from the content analysis of pre-existing comprehensive delirium guidelines: patient orientation including use of communication aids (glasses, hearing aids, dentures); optimise sleep–wake pattern; safety of patient environment; avoid unnecessary use of urinary catheters; encourage ADLs; promote safe mobility as tolerated (avoid use of physical restraints); assess and control pain; monitor hydration, nutrition, bowel and bladder function, pressure areas and assess for hypoxia; provide support and education to patient and family - Includes delirium “Care Tips” document as a reminder for nursing staff, accessible as a link in the EPR |
Tips for communicating with delirious patients | e-Learning module (with voiceover) (10 min) | All healthcare team (including ward clerks, and porter) | - Strategies derived from the content analysis of pre-existing comprehensive delirium guidelines, and from published literature on the patient delirium experience - Provides link to the European Delirium Association patient delirium experience teaching video [42] |
Pharmacological management of delirium in palliative care | e-Learning module (30–40 min) | Physicians, nursing, pharmacist | - Focuses on starting with a targeted approach of ‘as needed’ pharmacological interventions (if non-pharmacological interventions have been ineffective) for distressing delirium perceptual disturbances (e.g. hallucinations, illusions) or if safety concerns, with lower medication doses for older or frail patients - Highlights importance of medication review and deprescribing, and adverse effects of pharmacological interventions, e.g. EPS with APs, avoid haloperidol in patients with Parkinson’s Disease or Dementia with Lewy bodies, possible increased patient agitation and delirium with APs and BDZs - Uses 4 interactive patient cases to illustrate different scenarios - Downloadable prescribing ‘framework’ document (Adapted from [37]) |
Patient/ family education | Bilingual (English and French) delirium information leaflets[43] | Patients and their families | - Includes signs and symptoms of delirium; how to communicate with a person who has delirium; how the family can help care for the person with delirium |
Implementation resources | Format | Intended Audience | Notes |
(1) Accessible ‘Big Picture summary’ of the modular delirium guideline | 2-sided laminated sheet: Page 1: brief overview summary of delirium guideline modules Page 2: summary of pharmacological management for distressing delirium symptoms | Nursing, physicians, pharmacist, medical learners | Inserted at front of all patient binders for medication administration records as a point-of-care tool |
(2) Guideline algorithm for the management of delirium in palliative care patients | Wall poster (using same colours as guideline modules) | Clinical staff | Posted in prominent position in each of the PCU charting rooms (Adapted from [1]) |