An educational intervention can prevent delirium on acute medical wards

Abstract

Background: Delirium is a common disorder in hospitalised older people and established cases may have a poor outcome that is not readily improved by intervention. Prevention of cases through education of medical and nursing staff has not been fully studied.

Objectives: To test the hypothesis that an educational package for medical and nursing staff would both reduce the number of incident cases of delirium and increase recognition of cases of delirium within an acute medical admissions ward.

Design: Single-blind case-control study.

Setting: Two acute admissions wards in a busy inner-city teaching hospital.

Subjects: 250 acute admissions over the age of 70 years.

Methods: An educational package for staff on one ward consisting of a 1 hour formal presentation and group discussion, written management guidelines and follow-up sessions. The follow-up sessions, which were based on one-to-one and group discussions, aimed at providing continuous support of staff through emphasising learning and testing knowledge. Diagnosis and management of some discharged delirium patients were also discussed to allow staff to learn from previous experience. The main outcome measures are point prevalence of delirium established by researchers, and recognition and case-note documentation of delirium by clinical staff.

Results: The point prevalence of delirium was significantly reduced on the intervention compared to the control ward (9.8% versus 19.5%, P < 0.05) and clinical staff recognised significantly more delirium cases that had been detected by research staff on the ward where the educational package had been delivered.

Conclusion: A focused and inexpensive educational programme can decrease the prevalence of delirium among older inpatients.