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Evaluation of the delirium early monitoring system (DEMS)

Published online by Cambridge University Press:  22 July 2016

Daniel Rippon ,
Koen Milisen ,
Elke Detroyer ,
Elizabeta Mukaetova-Ladinska ,
Beth Harrison ,
Marieke Schuurmans ,
Claire Pryor  and
Andrew Teodorczuk
Daniel Rippon
Affiliation:
Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
Koen Milisen
Affiliation:
Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
Elke Detroyer
Affiliation:
Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
Elizabeta Mukaetova-Ladinska
Affiliation:
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Beth Harrison
Affiliation:
Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
Marieke Schuurmans
Affiliation:
University Medical Centre Utrecht, Utrecht, the Netherlands
Claire Pryor
Affiliation:
Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
Andrew Teodorczuk*
Affiliation:
Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK School of Medicine and Health Institute for the Development of Education and Scholarship (Health IDEAS), Griffith University, Queensland, Australia
*
Correspondence should be addressed to: Andrew Teodorczuk, School of Medicine, G40, Gold Coast Campus, Griffith University, QLD 4222, Australia. Phone: +61 756780891. Email: a.teodorczuk@griffith.edu.au.
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Abstract

Background:

Despite awareness of the negative health and financial outcomes of delirium, systems to routinely assess and manage the condition are absent in clinical practice. We report the development and pilot evaluation of a Delirium Early Monitoring System (DEMS), designed to be completed by non-medical staff to influence clinical processes within inpatient settings. Two versions of the DEMS are described based on a modified Confusion Assessment Method (DEMS-CAM) and Delirium Observation Screening Scale (DEMS-DOSS).

Methods:

Both versions of DEMS were piloted on a 20-bedded Psychogeriatric ward over 6 weeks. Training was administered to ward staff on the use of each version of the DEMS and data were collected via electronic medical records and completed assessment sheets. The primary outcome was patterns of DEMS use and the secondary outcome was the initiation of delirium management protocols. Data regarding the use of the DEMS DOSS and DEMS CAMS were analyzed using χ2 tests.

Results:

Completion rates for the DEMS CAM and DEMS DOSS were 79% and 68%, respectively. Non-medical staff were significantly more likely to use the DEMS-CAM as part of daily practice as opposed to the DEMS-DOSS (p<0.001). However, there was no difference between the use of the DEMS-CAM and DEMS-DOSS in triggering related actions such as documentation of assessment scores in patients’ medical records and implementation of delirium management protocols.

Conclusions:

This real world evaluation revealed that non-medical staff were able to incorporate delirium monitoring into their practice, on the majority of occasions, as part of their daily working routine. Further research is necessary to determine if the routine use of the DEMS can lead to improved understandings and practice of non-medical staff regarding delirium detection.

Keywords

deliriumeducationdementiapracticedetection
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 11 , November 2016 , pp. 1879 - 1887
Copyright
Copyright © International Psychogeriatric Association 2016 

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