evidence base

Clinical Question

PICOT Question: In hospitalized adult patients, does the implementation of a multidisciplinary delirium prevention program compared to standard care reduce the incidence of delirium during hospitalization?

The proposed evidence-based practice change is to implement a multidisciplinary delirium prevention program in hospitalized adult patients to reduce the incidence of delirium during hospitalization. The program would involve healthcare professionals from various specialties collaborating to identify delirium risk factors and create a strategy to lower these risks. The team would also educate patients and their families about delirium's warning signs and symptoms and ways to avoid it (Ramnarain et al., 2023). This proposed intervention holds promise in improving patient outcomes in the population of interest, as it could reduce the incidence of delirium during hospitalization.

Synthesis of Evidence

The review of literature suggests that the implementation of a multidisciplinary delirium prevention program for hospitalized adult patients is a promising intervention for reducing the incidence of delirium during hospitalization. Studies have shown that delirium prevention programs that include strategies such as reorientation, environmental modification, early mobilization, medication management, and nutritional support can reduce the incidence of delirium (Ramnarain et al., 2023). Additionally, these programs may also improve patient outcomes such as decreased morbidity, mortality, length of hospital stay, and healthcare costs (Marcantonio et al., 2017). Thus, the implementation of a multidisciplinary delirium prevention program is a promising intervention for decreasing the incidence of delirium in hospitalized adult patients.

Project Team

The members of the EBP project team include healthcare professionals from various specialties, such as nurses, doctors, pharmacists, physical therapists, occupational therapists, and other healthcare providers (Ramnarain et al., 2023). Additionally, stakeholders for the change in practice, such as patients, their families, and the healthcare organization, should also be included in the project team. This team will be responsible for identifying delirium risk factors, developing a strategy to lower these risks, educating patients and their families about delirium's warning signs and symptoms, and providing adequate training and support to healthcare professionals to ensure that they have the necessary skills and resources to implement the program effectively.

Barriers

The implementation of the multidisciplinary delirium prevention program may face various barriers. These barriers could include the organization's culture, anticipated reaction to change, and my leadership role for change. To address the culture of the organization, it is essential to foster a culture of collaboration, communication, and teamwork. To address the anticipated resistance to change, it is essential to involve healthcare professionals in the decision-making process and provide them with evidence-based practices. Additionally, it is crucial to provide adequate training and support to healthcare professionals to ensure that they have the necessary skills and resources to implement the program effectively. My leadership role for change could also pose a barrier, and I must ensure that I am leading by example and ensuring that healthcare professionals are adequately trained and supported in implementing the program (Mansaray, 2019). To overcome these barriers, it is essential to involve all stakeholders in the decision-making process and provide clear communication and prompt resolution of any issues that arise.

Facilitation Plan

As the leader of the EBP project team, my leadership plan will include identifying colleagues from various specialties to participate in the multidisciplinary delirium prevention program, deciding on each team member's tasks and responsibilities, ensuring they have received the necessary delirium prevention training, and determining the resources required for the program, such as additional personnel and equipment. To facilitate change, I will need to involve all stakeholders in the decision-making process and address any concerns or issues that arise promptly. Additionally, I will need to provide education and evidence-based practices to healthcare professionals, foster a culture of collaboration, communication, and teamwork, and ensure that healthcare professionals have received adequate training and support to implement the program effectively (Clark et al., 2019).

Evaluation Plan

The outcome of the proposed change will be measured by evaluating the incidence of delirium during hospitalization. To evaluate this outcome, delirium screening tools such as the Confusion Assessment Method (CAM) can be used to identify patients at risk for delirium and monitor their progress (Young et al., 2022). Additionally, data on patient outcomes such as morbidity, mortality, length of hospital stay, and healthcare costs can be collected and analyzed to determine the effectiveness of the program. This evaluation will need to be conducted on an ongoing basis to ensure that the program is effective in reducing the incidence of delirium during hospitalization

Implementation Plan

The implementation plan should include a timeline, plans for education, roles for team members, marketing, and equipment needs (including any costs associated with change). The timeline should include the steps necessary to implement the program, such as identification of team members, training, development of protocols, and marketing. The education plan should include workshops, seminars, and online resources to ensure that healthcare professionals are adequately trained and supported in implementing the program. The roles for team members should be clearly defined, and the marketing plan should include strategies to promote the program and its benefits. Finally, the equipment needs should be identified, and any costs associated with the program should be considered.

References

Clark, L. T., Watkins, L., Piña, I. L., Elmer, M., Akinboboye, O., Gorham, M., Jamerson, B., McCullough, C., Pierre, C., Polis, A. B., Puckrein, G., & Regnante, J. M. (2019). Increasing Diversity in Clinical Trials: Overcoming Critical Barriers. Current Problems in Cardiology, 44(5), 148–172. https://doi.org/10.1016/j.cpcardiol.2018.11.002

Mansaray, H. E. (2019). The Role of Leadership Style in Organisational Change Management: A Literature Review. Journal of Human Resource Management, 7(1), 18–31. sciencepublishinggroup. https://doi.org/10.11648/j.jhrm.20190701.13

Marcantonio, E. R. (2017). Delirium in Hospitalized Older Adults. New England Journal of Medicine, 377(15), 1456–1466. https://doi.org/10.1056/nejmcp1605501

Ramnarain, D., Pouwels, S., Fernández‐Gonzalo, S., Navarra‐Ventura, G., & Balanzá‐Martinez, V. (2023). Delirium–related psychiatric and neurocognitive impairment and the association with post intensive care syndrome‐ a narrative review. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13534

Young, M., Holmes, N., Kishore, K., Marhoon, N., Amjad, S., Serpa-Neto, A., & Bellomo, R. (2022). Natural language processing diagnosed behavioral disturbance vs confusion assessment method for the intensive care unit: prevalence, patient characteristics, overlap, and association with treatment and outcome. Intensive Care Medicine, 48(5), 559–569. https://doi.org/10.1007/s00134-022-06650-z