None listed
Conditions
Brief summary
This is a pilot study using technologically advanced customised distraction techniques to prevent and manage acute behavioural disturbance (ABD) in elderly patients in the emergency department (ED). Acute behavioural disturbance is a common problem in EDs, particularly in elderly patients and even more so in those with cognitive impairment, for example people with delirium or dementia. This behaviour endangers the patients themselves, their companions, other patients and ED staff, and hampers timely delivery of their care. Current treatment options, including psychotropic medication and mechanical restraint remain of limited benefit, confer risk and are of limited efficacy. Despite recognition that they are preferred practice, distraction techniques are rarely used in the management of patients with ABD in the ED setting; with the vast majority of cases managed using psychotropic medications, often administered parenterally, and often without patient consent under the Principle of Necessity. These medications have significant adverse effect profiles; complications can include over-sedation with hypoxia or hypotension, falls and subsequent injuries as well as prolonged lengths of stay and increased mortality. In the ED, available non-pharmacological options are limited, rendering the investigation of distraction techniques such as the use of virtual reality (VR) and other multimedia approaches in this setting an important initiative. We aim to perform an iterative process of testing, adaptation and refinement of devices and media to develop customised distraction techniques for elderly patients who exhibit ABD in Cabrini ED.
Interventions
We will test various technologies to provide multimedia distraction, including immersive Virtual Reality (VR) headsets with and without audio; close-proximity screens, with and without audio, and other relevant devices such as audio devices alone. Devices included will be a VR headset: Oculus Quest 64GB, and an immersive multimedia screen to fill patients field of view without the need for a headset. This consists of a curved monitor display (such as LG 38WK95C-W) mounted to a cart with an artic
We will test various technologies to provide multimedia distraction, including immersive Virtual Reality (VR) headsets with and without audio; close-proximity screens, with and without audio, and other relevant devices such as audio devices alone. Devices included will be a VR headset: Oculus Quest 64GB, and an immersive multimedia screen to fill patients field of view without the need for a headset. This consists of a curved monitor display (such as LG 38WK95C-W) mounted to a cart with an articulating arm (enabling it to be positioned directly in front of the patient) such as the PDI MedTV Cart. Therefore there are two devices being used, however these may be modified in an iterative fashion as the project progresses. The actual imagery we will test may include, but is not limited to, nature scenes (eg walking in a forest), underwater scenery, geometric patterns, imagery of different world cities etc. The intervention will be delivered by a research assistant, who will guide the user through and collect data. Each participant will use more than one device, with a maximum of three devices, but will only be allocated to a single sitting. Total participation time will be limited to 1 hour. The location will be either in a residential aged care facility, or in the emergency department of Cabrini Hospital. The number of devices used will be determined by the maximum time frame of 1 hour as well as patient discretion. The three (stepwise) stages are: 1. Healthy volunteers 2. Residents with known cognitive impairment 3. ED patients with acute behavioural disturbance
Sponsors
Cabrini Health
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Stage 1 Healthy volunteers Stage 2 Residents with known cognitive impairment Stage 3 ED patients with Acute Behavioural Disturbance (ABD)
Exclusion criteria
Stage 1 Cognitive impairment Hearing or sight impaired Significant limitations in manual dexterity, e.g. inability to operate simple controls Insufficient English to understand an explanation of the study and provide consent Stage 2 ? Hearing or sight impaired ? Acutely behaviourally disturbed Stage 3 ? Patients meeting “Code Grey” criteria i.e. violence or severe agitation ? Patients previously enrolled in the ED setting
Outcome results
None listed