None listed
Conditions
Brief summary
Background: Older people who present to the Emergency Department experience high rates of prevalent and incident delirium. This study aimed to determine whether an assistant workforce in the Emergency Department could effectively conduct screening to inform assessment and care planning of older persons as well as provide supportive care activities for prevention of delirium. Methods: This study used a pre-post design. Data was collected before and after the introduction of Older Person Technical Assistants (OPTAs) in the ED and included: recording of OPTA activity during the intervention period; a medical record audit undertaken prior to the implementation and 9 months after implementation; and focus group interviews with Emergency Department Staff. The data was analysed using descriptive statistics to describe the activity of the OPTAs. Weighted Kappa scores were calculated to compare the concordance between OPTA screening scores with Aged Services Emergency Team (ASET) Nurses; changes in the rates of documented screening and supportive care that is recommended in the prevention and care of people with or at risk of developing delirium. Qualitative descriptive analysis was used to examine focus group data. Results: 3542 people were seen on 4563 visits by OPTAs between 1st July 2011 and 2012. The reproducibility of all screening tools were found to be very high between the OPTAs and the RNs, with Kappas and ICCs generally all above 0.9. The medical record audit showed significant improvement in the rates of documented screening, including cognition from 1.5% to 38% (p<0.001) and review of pain from 29% to 75% (p<0.001). Supportive care related to delirium prevention also improved with patients being given fluids or food increasing from 13% to 49% (p< 0.001) and pressure care from 4.8% to 30% (p,0.001). Focus group interviews describe mixed response and support of the OPTA role in the ED. Conclusions: An assistant workforce deployed in an ED setting was found to provide comparable screening results and improve the rates of documented screening and supportive care provided to older people with or at risk of developing delirium in the ED. Implementation of such a model of care requires dedicated staff, robust screening, and comprehensive and systematic assessment and management of care and ongoing treatment.
Interventions
The intervention was four full time equivalent (FTE) Older Person Technical Assistants (OPTAs) will be rostered between 8 am to 8pm in the ED, seven days a week for 12 months in 8 hour shifts. The OPTAs focus on screening and the supportive care of people over the age of 75 years who were not experiencing life threatening situations.
The prerequisites for selection as an OPTA include previous training or experience as a health care assistant or equivalent. On commencement in the ED, over a 5 d
The intervention was four full time equivalent (FTE) Older Person Technical Assistants (OPTAs) will be rostered between 8 am to 8pm in the ED, seven days a week for 12 months in 8 hour shifts. The OPTAs focus on screening and the supportive care of people over the age of 75 years who were not experiencing life threatening situations. The prerequisites for selection as an OPTA include previous training or experience as a health care assistant or equivalent. On commencement in the ED, over a 5 day period ,the OPTAs will be oriented to the ED and hospital environment, trained and assessed in competency as assistants in nursing, patient privacy and dignity as well as the screening tools. They will be instructed on recording screening findings and supportive care in the electronic patient management system. Screening undertaken includes: *Six item screener, a brief cognitive assessment screen designed for EDs *Confusion Assessment Method Instrument (CAMI) for delirium *Falls Risk for Hospitalised Older People, a falls screening tool *Identification of Seniors at Risk, a tool to identify patients at risk for ED representation *Numerical rating scale for pain *Waterlow screening tool for pressure injury risk screening *Mini-Nutritional Assessment for nutrition and *Modified Care Strain Index to screen for caregiver strain with long-term family caregivers. In line with Australian clinical practice guidelines for the management of people with delirium, preventative environmental and clinical practice strategies are incorporated into the role. This multicomponent delirium prevention strategy consists of orienting the person to the ED environment, attending to nutrition, hydration and elimination needs, providing sensory and mobility aids, supervising and assisting moving, support when agitated and facilitating carer presence as often as possible. A delirium prevention box is available for OPTAs to use with patients this included daily newspapers, playing cards, games and puzzles, crosswords, a radio with ear phones and a clock. OPTAs also provided support to carers in the ED who are often older people themselves. The setting is a tertiary referral hospital Emergency Department in New South Wales, Australia. In the year prior to this study, the ED had 67,000 ED presentations, 13 % of which were by patients over 75 years of age.
Sponsors
John Hunter Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
75 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients presenting to the Emergency Department
Exclusion criteria
Patients who are critically unwell, requiring resuscitation and patients who are have low complexity presentations and most likely discharged from hospital
Outcome results
None listed