Does delirium prevention reduce risk of in-patient falls among older adults? A systematic review and trial sequential meta-analysis.

OBJECTIVES: To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients. METHODS: A systematic search of health-care databases was undertaken. Given the frequency of small sample sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels. RESULTS: Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control; however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32; 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively. CONCLUSIONS: The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients.

Nursing assessment and management of incontinence among medical and surgical adult patients in a tertiary hospital: a best practice implementation project.

OBJECTIVES: The objectives of this implementation project were to review the nursing assessment and management of adult patients with urinary and fecal incontinence, and to develop local guidelines and ward-based continence assessment tools to assist nursing staff in assessing and managing incontinence. INTRODUCTION: Urinary or fecal incontinence in acute care hospitals is a growing issue that can lead to constipation, depression, breakdown of skin integrity, increased nursing home placement of older patients, increased length of hospital stay, and escalated healthcare costs. In many cases, incontinence can be treated and managed effectively; however, it is poorly understood and under-prioritized in many hospital settings. METHODS: A pre-post intervention chart audit was conducted to review compliance with 10 best-practice criteria for incontinence assessment and management. Following baseline data analysis, barriers to compliance with the criteria were identified and subsequently addressed using targeted strategies. The project utilized the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) tools. RESULTS: Education on continence strategies was delivered to nursing staff, which resulted in improved compliance for all audit criteria. There were notable improvements in the nursing documentation, and assessment and management of patients with urinary and/or fecal incontinence in the post-intervention analysis. CONCLUSIONS: The results demonstrate that nursing education and formalized assessment pathways in an acute setting can improve nursing compliance with the assessment and management of patients with either urinary or fecal incontinence to ensure safe, compassionate and person-centered care.

Nutritional screening, assessment and implementation strategies for adults in an Australian acute tertiary hospital: a best practice implementation report.

OBJECTIVE: The project aimed to improve the effectiveness of nutritional screening and assessment practices through clinical audits and the implementation of evidence-based practice recommendations. INTRODUCTION: In the absence of optimal nutrition, health may decline and potentially manifest as adverse health outcomes. In a hospitalized person, poor nutrition may adversely impact on the person's outcome. If the nutritional status can be ascertained, nutritional needs can be addressed and potential risks minimized.The overall purpose of this project was to review and monitor staff compliance with nutritional screening and assessment best practice recommendations ensuring there is timely, relevant and structured nutritional therapeutic practices that support safe, compassionate and person-centered care in adults in a tertiary hospital in South Western Sydney, Australia, in the acute care setting. METHODS: A baseline retrospective chart audit was conducted and measured against 10 best practice criteria in relation to nutritional screening and assessment practices. This was followed by a facilitated multidisciplinary focus group to identify targeted strategies, implementation of targeted strategies, and a post strategy implementation chart audit.The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRIP) tool, including evidence from other available supporting literature, for promoting change in healthcare practice. RESULTS: The baseline audit revealed deficits between current practice and best practice across the 10 criteria. Barriers for implementation of nutritional screening and assessment best practice criteria were identified by the focus group and an education strategy was implemented. There were improved outcomes across all best practice criteria in the follow-up audit. CONCLUSIONS: The baseline audit revealed gaps between current practice and best practice. Through the implementation of a targeted education program and resource package, outcomes improved in the follow up audit. The findings indicated that engagement from multidisciplinary team members and consumers was effective in developing tailored education that improved knowledge of best practice. This was demonstrated by an increase in the percentage of compliance across the 10 criteria, although leaving room for more improvement. A policy has been developed for implementation and future audits are planned to measure whether improved practices have been sustained.

Intentional rounding: facilitators, benefits and barriers.

AIMS AND OBJECTIVES: To describe the implementation, practice and sustainability of Intentional Rounding (IR) within two diverse settings (aged care and maternity). BACKGROUND: The profile of patients in hospitals has changed over time, generally being more severe, placing heavy demands on nurses' time. Routine non-urgent care is often provided only when there is time. IR has been found to increase both patient and staff satisfaction, also resulting in improved patient outcomes such as reduced falls and call bell use. IR is also used as a time management tool for safe and reliable provision of routine care. METHODS: This descriptive qualitative research study comprised of three focus groups in a metropolitan hospital. RESULTS: Fifteen nurses participated in three focus groups. Seven main themes emerged from the thematic analysis of the verbatim transcripts: implementation and maintenance, how IR works, roles and responsibilities, context and environment, benefits, barriers and legal issues. CONCLUSION: IR was quickly incorporated into normal practice, with clinicians being able to describe the main concepts and practices. IR was seen as a management tool, facilitating accountability and continuity of management support being essential for sustainability. Clinicians reported increases in patient and staff satisfaction, and the opportunity to provide patient education. While patient type and acuity, ward layout and staff experience affected the practice of IR, the principles of IR are robust enough to allow for differences in the ward specialty and patient type. However, care must be taken when implementing IR to reduce the risk of alienating experienced staff. Incorporation of IR charts into the patient health care record is recommended. RELEVANCE TO CLINICAL PRACTICE: Engaging all staff, encouraging ownership and stability of management are key factors in the successful implementation and maintenance of IR. IR is flexible and robust enough to accommodate different patient types and acuity.