Importance of specific vital signs in nurses' recognition and response to deteriorating patients: A scoping review.

AIM(S): To explore the published research related to nurses' documentation and use of vital signs in recognising and responding to deteriorating patients. DESIGN: Scoping review of international, peer-reviewed research studies. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature Complete, Medline Complete, American Psychological Association PsycInfo and Excerpta Medica were searched on 25 July 2023. REPORTING METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. RESULTS: Of 3880 potentially eligible publications, 32 were included. There were 26 studies of nurses' vital sign documentation: 21 adults and five paediatric. The most and least frequently documented vital signs were blood pressure and respiratory rate respectively. Seven studies focused on vital signs and rapid response activation or afferent limb failure. Five studies of vital signs used to trigger the rapid response system showed heart rate was the most frequent and respiratory rate and conscious state were the least frequent. Heart rate was least likely and oxygen saturation was most likely to be associated with afferent limb failure (n = 4 studies). CONCLUSION: Despite high reliance on using vital signs to recognise clinical deterioration and activate a response to deteriorating patients in hospital settings, nurses' documentation of vital signs and use of vital signs to activate rapid response systems is poorly understood. There were 21studies of nurses' vital sign documentation in adult patients and five studies related to children. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: A deeper understanding of nurses' decisions to assess (or not assess) specific vital signs, analysis of the value or importance nurses place (or not) on specific vital sign parameters is warranted. The influence of patient characteristics (such as age) or the clinical practice setting, and the impact of nurses' workflows of vital sign assessment warrants further investigation. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Evaluation of a method to estimate the point prevalence of cognitive impairment and delirium in a multi-campus Australian health service.

OBJECTIVE: To design, test (pilot) and implement a study to estimate the point prevalence of cognitive impairment (CI) and delirium in a multi-site health service. METHODS: Clinicians were trained to use the 4 A's Test (4AT) to screen for cognitive impairment and delirium, and the 3-minute Diagnostic Interview for the Confusion Assessment Method (3D-CAM) to detect delirium in those with abnormal 4AT results. Outcomes of interest were as follows: (a) rates of cognitive impairment and delirium and (b) feasibility of the approach measured by participation rate, "direct survey activity" time, cost and surveyor preparation. RESULTS: The rates of cognitive impairment and delirium were 43.8% (245/559) and 16.3% (91/559), respectively. 90.5% (563/622) of eligible adult patients from 25 acute and subacute wards were seen. "Direct survey activities" averaged 14 minutes (range 2-45) and cost $11.48 per patient. Training evaluation indicated additional education in the 4AT and 3D-CAM was needed. CONCLUSION: Health services could use this streamlined, inexpensive method to estimate the point prevalence of cognitive impairment and delirium.

Delirium management: Let's get physical? A systematic review and meta-analysis.

OBJECTIVE: To investigate whether physical training (alone or in a multi-component intervention) is effective in preventing delirium or improving outcomes for adult patients with delirium in the hospital setting. METHODS: A systematic review, qualitative synthesis and meta-analysis of randomised controlled trials identified by searches of electronic databases, combining key concepts of delirium and physical training (the target intervention). Outcomes were incidence of delirium (for prevention trials) and delirium duration, delirium severity and hospital outcomes (for management trials). RESULTS: Seven trials were included, five of which were multi-component. The odds of developing delirium were lower for patients who received physical training compared with a control intervention [odds ratio 0.46 (95% confidence interval 0.32-0.65), P < 0.01] (moderate-quality evidence). There was insufficient evidence to draw conclusions about managing established delirium. CONCLUSIONS: Strategies incorporating physical training appear to prevent delirium in the hospital setting. More research is required regarding management of established delirium.

Hospital discharge data under-reports delirium occurrence: results from a point prevalence survey of delirium in a major Australian health service.

BACKGROUND: Delirium in hospitalised patients is common, and a risk factor for adverse outcomes. Health services require accurate delirium data to monitor the impact of initiatives designed to improve detection and prevention of delirium. AIM: To determine the extent to which International Classification of Disease codes represent delirium occurrence. METHODS: A cross-sectional point prevalence survey was used to audit delirium occurrence in 25 inpatient wards of an Australian health service. All adult patients were eligible. Exclusion was for coma, end of life or behaviour that posed a risk to delirium assessors. Specially trained nurses and allied health professionals (AHP) screened patients for any cognitive impairment using the 4 A's Test (4AT). Those with abnormal screen test results were assessed using the '3-Minute Diagnostic Interview for the Confusion Assessment Method' (3D-CAM). Delirium detected by 3D-CAM was the reference standard. RESULTS: Of potentially eligible patients, 559 of 667 (83.8%) patients were assessed. The mean age was 73 years (±16.4), 54.5% were female and 43.8% (245/559) had cognitive impairment (4AT score ≥1). The occurrence of delirium during hospitalisation as identified by ICD codes was 10.4% (58/559; 95% confidence interval (CI), 7.9-12.7) compared with a point prevalence of 16.2% (91/559; 95% CI, 13.2-19.1). Only 31 of 91 (34.1%) of those with delirium had ICD delirium codes assigned. CONCLUSION: ICD coding is inadequate to determine in-hospital delirium incidence. Instead, a point prevalence detection of delirium using the methods described above could be used. Health services could apply the described survey method to evaluate their local initiatives for the improvement of delirium detection and prevention.