Investigation of ward fidelity to a multicomponent delirium prevention intervention during a multicentre, pragmatic, cluster randomised, controlled feasibility trial.
Investigation of ward fidelity to a multicomponent delirium prevention intervention during a multicentre, pragmatic, cluster randomised, controlled feasibility trial.
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在多中心、务实、整群随机、对照可行性试验中调查病房对多成分谵妄预防干预措施的忠诚度。
DOI：
10.1093/ageing/afaa042
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发表时间：
2020
期刊：
影响因子：
6.7
通讯作者：
Young,John
中科院分区：
文献类型：
--
作者：
Smith,Jane;Green,John;Siddiqi,Najma;Inouye,SharonK;Collinson,Michelle;Farrin,Amanda;Young,John
背景谵妄是老年人住院的常见并发症，可以通过多组分干预来减少，但实施和提供此类干预是具有挑战性的。在英格兰和威尔士的八家医院中设置五个老年人护理和三个骨科创伤病房。观察病房实践;病例记录审查和文件检查。评估10名具有老年人护理经验的卫生保健专业人员评估了以下四个领域中21个基本实施组件的忠诚度：干预安装（5个项目;最高分= 5）;干预交付（12个项目;最高分= 48）;干预范围（三个项目;最高分= 16）;和分娩时间结果各领域的平均得分（范围）为：安装4.5（3.5-5）;交付32.6（范围27.3-38.3）;覆盖率7.9（范围4.2-10.1）;持续时间0.38（0-1）。在10个谵妄危险因素中，感染、营养、缺氧和疼痛最多，认知障碍、感觉障碍和多种药物治疗最少。整体保真度的干预被评估为高（≥80%）在两个病房，中等（51-79%）在五个病房和低（≤50%）在一个wow.Conclusionthe试验的目的是作为一个务实的评价，和中等干预保真度的调查结果很可能是generalizable谵妄预防在常规护理，并提供了一个重要的背景来解释试验结果。
Backgrounddelirium is a frequent complication of hospital admission for older people and can be reduced by multicomponent interventions, but implementation and delivery of such interventions is challenging.Objectiveto investigate fidelity to the prevention of delirium system of care within a multicentre, pragmatic, cluster randomised, controlled feasibility trial.Settingfive care of older people and three orthopaedic trauma wards in eight hospitals in England and Wales.Data collectionresearch nurse observations of ward practice; case note reviews and examination of documentation.Assessment10 health care professionals with experience in older people’s care assessed the fidelity to 21 essential implementation components within four domains: intervention installation (five items; maximum score = 5); intervention delivery (12 items; maximum score = 48); intervention coverage (three items; maximum score = 16); and duration of delivery (one item; maximum score = 1).Resultsthe mean score (range) for each domain was: installation 4.5 (3.5–5); delivery 32.6 (range 27.3–38.3); coverage 7.9 (range 4.2–10.1); and duration 0.38 (0–1). Of the 10 delirium risk factors, infection, nutrition, hypoxia and pain were the most and cognitive impairment, sensory impairment and multiple medications the least consistently addressed. Overall fidelity to the intervention was assessed as high (≥80%) in two wards, medium (51–79%) in five wards and low (≤50%) in one ward.Conclusionthe trial was designed as a pragmatic evaluation, and the findings of medium intervention fidelity are likely to be generalisable to delirium prevention in routine care and provide an important context to interpret the trial outcomes.