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American Delirium Society october 2018 BiMonthly Newsletter

New Member Benefits Coming Soon

As the temperatures begin to drop and the leaves start to fall, change is in the air. The American Delirium Society has been reviewing the benefits it provides to its members, including information and resources available on the ADS website.

One new benefit for members to look forward to will be a Members Only section of the website. In this section, ADS plans to include past meeting materials, a membership directory to search and contact your colleagues, educational material assembled by the ADS Education Committee, and an ADS members listserv.

We look forward to implementing these changes and introducing them to the membership so that you can stay up-to-date as we look forward to the Annual Meeting next June 16-18 in Boston. You can expect e-mail updates as we get closer to launching new features.

Sincerely,

Scott Mattson

ADS Executive Director

Delirium Down Under: ADS @ ADA

Contributed by ADS Board Member: James Rudolph, MD, SM

Preconference workshop presented by ADS Board Members: Rakesh Arora, Noll Campbell, Babar Ali Khan, Pratik Pandharipande, and James Rudolph.

While water may swirl in the opposite direction, seasons are reversed, and they drive on the wrong side of the road, delirium in Australia is a common, morbid, and costly condition. In a gesture of unity among delirium professionals, ADS Board Members traveled to Melbourne, Australia to collaborate with the Australasian Delirium Association.

The ADS and ADA co-sponsored the pre-conference session, where the audience of over 100 professionals engaged in lectures, interactive learning, and simulation to develop a more thorough understanding of delirium. At the close, the audience expressed warm Aussie gratitude toward the speakers and the presenters went for a night of food and fun. Want to be included for Brisbane in Sept 2020?

Best Practices in Teaching & Reinforcing Interprofessional Delirium Competencies Across Practice Settings

Workshop content developed & originally presented with Claire Copeland, MBCHB; Robert Dicks, MD, FACP; Mary Kate Eanniello, DNP-c, RN, ONC; Cynthia Holle, DN; Gwen Redler, MSN, RN, RRT; Anna Satake, MSN, RN; Elizabeth Udeh, PharmD, BCPS; and Christine Waszynski DNP, RN, GNP-C. (Pictured at the Workshop: Cynthia Holle, DNP, Kerri Maya, MSN, Anna Satake, RN, MSN)

Synopsis by Kerri Maya, MSL, RN, PHN, Sutter Santa Rosa Regional Hospital & University of California, Davis

On June 12th, a group of delirium education professionals from various health organizations spanning two continents came together to form a cohesive group ready to demonstrate interprofessional collaboration in action!

The goal of this group was to lay the groundwork for development of a set of internationally-appropriate standardized delirium competencies that could be applied across practice settings. In the process, our group demonstrated best practices in learner-centered professional education strategies that could be adapted for use in the various practice settings including: Critical Care, Med-Surg, Post-Acute or LTC, and Home Health/ Hospice settings. On-going work also includes standardized competencies for Emergency and Pediatric practice settings.

Key Takeaways:

  • Why are standardized delirium education competencies necessary? Currently, delirium recognition rates and effective management often remain poor even after education is provided. Competencies in healthcare define the skills and knowledge necessary to enable teams to successfully perform the expected assessments, mitigation of risk factors, and interventions intended to facilitate individuals attaining the highest level of health possible. Without competencies, how do we measure the quality of knowledge delivered or the success of knowledge transmission?
  • How we provide delirium education matters! Recommendations include interactive and multifaceted education taught in interprofessional (IP) groups, allowing various disciplines to learn from and with each other. Methodologies should be chosen that are engaging and immersive such as case studies, simulation, small-group discussion, reflection, and script concordance testing. These strategies can then be paired with enabling and reinforcing interventions such as 1:1 observation and feedback to target specific barriers or needs. Additionally, education should focus on IP team collaboration and standardized communication training that facilitates dialogue with patients, family members, and other individual members of the IP team.
  • Who should participate in IP delirium education? Depending on the practice setting, recommended team members include:
  • Family members & caregivers (or those with first-hand testimonials)
  • Executive Champions (e.g. CNO, CMO, COO)
  • Delirium Champions (e.g. CNS, unit educators)
  • Nurses (e.g. bedside, charge)
  • Physicians (e.g. attending, residents, and specialty including CV, ID, Palliative Care)
  • Pharmacists
  • Respiratory Therapists
  • Physical & Occupational Therapists
  • Social Workers & Case Managers
  • Child Life Specialists
  • Ethics Consultants
  • Nutritionists
  • Aides & Volunteers
  • Security
  • Interdisciplinary students from all disciplines
  • Auxiliary team members (e.g. Chaplain/ Spiritual Care, Environmental Services)
  • What content should be included in delirium education? Workshop attendees helped identify key educational content necessary to develop delirium competence and confidence in management ability. Our group intends to fine-tune these standardized competencies across practice settings via expert review for dissemination in the near-future.

Delirium in adult cancer patients: ESMO Clinical Practice Guidelines

Bush SH, Lawlor PG, Ryan K, Centeno C, Lucchesi M, Kanji S, Siddiqi N, Morandi A, Davis DHJ, Laurent M, Schofield N, Barallat E, Ripamonti CI; ESMO Guidelines Committee. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018 July 10. doi: 10.1093/annonc/mdy147. [Epub ahead of print]

In 2017, the European Society for Medical Oncology (ESMO) invited a team of deliriophiles to create a new clinically-focused guideline on delirium.

Dr. Shirley Bush led the international multidisciplinary and interprofessional guideline development team which consisted of palliative care physicians, oncologists, geriatricians, a psychiatrist, a pharmacist, and specialist nurses from across Europe and Canada.

Guideline development committee members were predominantly from across Europe, with a satellite group in Ottawa, Canada!

Over an intense 6-month period, teams of 2-3 researchers collaborated to review and write up the evidence, including grades of recommendations for each section. Importantly, by identifying gaps in the published literature, recommendations for future research are also provided.

The final ESMO guideline includes algorithms and practical tables to assist busy clinicians, plus an appendix with supplementary material.

The new EMSO delirium guideline has been recently published in the Annals of Oncology and can be accessed here:

https://doi.org/10.1093/annonc/mdy147

A Delirium Management Program Workflow

Anna Satake RN, GCNS

Kaiser Permanente Vacaville, CA

Kaiser Permanente Foundation Hospital in Vacaville, California embarked on a journey to create a Delirium Program in 2016. The development of the program started with clarifying roles and responsibilities in identification and management of delirium. Role clarity and workflow of different disciplines helped to identify the importance of a team approach. The Delirium team, which was a new concept at this hospital, consisted of a Geriatric Clinical Nurse Specialist and a Psychiatrist. The Delirium team was developed to be a collaborative participant in helping manage complex patients with delirium, allowing consults from nurses or physicians.

In the first 6 months after Delirium team implementation, there was a 13.8% (.5 days) decrease in average length of stay for patients with a delirium diagnosis. Over the next 6 months delirium education was provided, which included physicians, nurses, rehab, MSW, and Patient Care Technicians regarding their role and responsibility in identifying, preventing and managing delirium. This comprehensive education across disciplines and departments was very effective. The average length of stay of patients with a delirium diagnosis continued to decline by 24% (1.7 days) compared to before program initiation.

There have been several learnings from the creation of this program. It was important to cast a wide net and include the many roles and departments that assist in delirium prevention and management. The inclusion of multidisciplinary roles in education was important to help ensure there was a shared sense of importance regarding early identification and management for better team collaboration and care planning. Patients benefited from having more informed and collaborative care teams that could recognize and manage delirium.

Join the ADS Education Committee!

The committee is currently working on how to both increase the value of membership in ADS and to enhance the access to quality education for the delirium community. To learn more contact the Board Liaison: Christine Waszyinski: Christine.Waszynski@hhchealth.org

Created By
Liz Archambault
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Created with images by corgaasbeek - "care hospital room bed new enschede hospital"

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