Get documents about "Delirium Risk Assessment Sticker
Document Sample
Tool and Resource Evaluation Template
Adapted by NARI from an evaluation template created by Melbourne Health.
Some questions may not be applicable to every tool and resource.
Name and purpose Name of the resource: The Delirium Risk Assessment Sticker
Author(s) of the resource:
Ms Julia Poole, Ms Brandi Cole, Dr Sue Ogle, Dr Terry Finnegan
Northern Sydney Central Coast Health Service
Please state why the resource was developed and what gap it proposes to fill:
The resource was developed as part of a Clinical Redesign Project, conducted between October
and December 2007. The aim of which was to provide best practice prevention and management
of delirium and dementia by providing staff with education and tools to assist in the recognition of
these conditions; and by doing so reduce restraint use and adverse events.
The Delirium Risk Assessment (DRA) Sticker is based on information contained in Clinical practice
1
guidelines for the management of delirium in older people . It provides a useful prompt for clinical
staff in terms of risk factors, prevention, diagnosis and management of delirium.
Evaluation of the DRA sticker, in the abovementioned Clinical Redesign Project, showed that it
improved staff awareness of delirium and delirium risk factors and increased delirium recognition.
Target audience Please check all that apply:
(the tool is to be
used by) Health service users Carers
Medical staff Nursing staff Any member of an interdisciplinary team
Medical specialist, please specify:
Specific allied health staff, please specify:
Other, please specify:
Target Is the resource targeted for a specific setting? Please check all that apply:
population/setting
(to be used on/in) Emergency Department Inpatient acute Inpatient subacute Ambulatory
Other, please specify:
For which particular health service users would you use this resource (e.g. a person with
suspected cognitive impairment)?
Persons aged 70 years and over and those with existing cognitive impairment are at high risk for
the development of delirium, but many other risk factors exist.
Structure of tool Website Education package Video
Pamphlet Assessment tool Screening tool
Methodology Resource guide Awareness raising resource (posters etc.)
Other, please specify:
Please state the size of the resource (e.g. number of pages, minutes to read):
The Delirium Risk Assessment (DRA) Sticker is a half-page table comprising information on risk
factors for the development of delirium, recommended investigations if delirium is suspected and
strategies that can be useful in both the prevention of delirium and management of symptoms.
The DRA Sticker can be printed two-to-a-page, using full-page A4 label sheets. These are then
peeled off and stuck on to progress notes in the patients’ medical record.
Availability and Is the resource readily available? Yes No Unknown Not applicable
cost of tool
Is there a cost for the resource? Yes No Unknown Not applicable
Please state how to get the resource:
A copy of the DRA sticker is provided below:
Delirium Risk Screen Sticker
For further information, contact
Julia Poole, Clinical Nurse Consultant, Aged Care
Dept of Aged Care & Rehabilitation Medicine,
Building 10, Royal North Shore Hospital
ST LEONARDS NSW AUSTRALIA, 2065
jpoole@nsccahs.health.nsw.gov.au
Applicability to Is the resource suitable for use in rural health services (e.g. the necessary staff are usually
rural settings and available in rural settings)? Yes No Unknown Not applicable
culturally and Is the resource available in different languages?
linguistically
diverse Yes No Unknown Not applicable
populations
Is the content appropriate for different cultural groups?
Yes No Unknown Not applicable
Person-centred Does the resource adhere to/promote person-centred health care?
principles Yes No Unknown Not applicable
Training Is additional training necessary to use the resource?
requirements Yes No Unknown Not applicable
If applicable, please state how extensive any training is, and what resources are required:
Use of the DRA sticker requires familiarity with the resources from which it was developed, e.g.
Clinical practice guidelines for the management of delirium in older people1 and the Confusion
2
Assessment Method (CAM) . Reviews have been included in the toolkit for both resources.
Administration How long does the resource take to use? 0-5 mins 5-15 mins 15-25mins 25mins +
details The DRA sticker may be completed over time. On admission, the risk factors/risk score section
may be all that is completed. However a change in behaviour, function and/or cognition would see
the investigations section completed.
Can the resource be used as a standalone, or must it be used in conjunction with other
tools, resources, and procedures?
Standalone
Must be used with other resources, please specify: Clinical practice guidelines for the
1 2 3
management of delirium in older people , CAM , validated cognitive assessments such as AMT
4
and MMSE .
Can be used with other tools, please specify:
Data collection and Are additional resources required to collect and analyse data from the resource?
analysis
Yes No Unknown Not applicable
If applicable, please state any special resources required (e.g. computer software):
Additional resources are required to collect the data necessary to complete the Delirium Risk
Assessment. See administration details (above)
Sensitivity and Sensitivity is the proportion of people that will be correctly identified by the tool.
specificity Specificity is the probability that an individual who does not have the condition being tested
for will be correctly identified as negative.
Has the sensitivity and specificity of the resource been reported?
Yes No Unknown Not applicable
If applicable, please state what has been reported:
While sensitivity of the DRA sticker itself has not been reported, the tool is based on clinical
guidelines and the use of instruments that are well validated.
Face Validity Does the resource appear to meet the intended purpose?
Yes No Unknown Not applicable
Reliability Reliability is the extent to which the tool’s measurements remain consistent over repeated
tests of the same subject under identical conditions. Inter-rater reliability measures
whether independent assessors will give similar scores under similar conditions.
Has the reliability of the resource been reported?
Yes No Unknown Not applicable
If applicable, please state what has been reported:
While reliability of the DRA sticker itself has not been reported, the tool is based on clinical
guidelines and the use of instruments that are well validated.
Strengths What are the strengths of the resource? Is the resource easy to understand and use? Are
instructions provided on how to use the resource? Is the resource visually well presented
(images, colour, font type/ size)? Does the resource use older friendly terminology (where
relevant), avoiding jargon?
Please state any other known strengths, using dot points:
• Based on Clinical practice guidelines for the management of delirium in older people1
• Provides useful prompts for clinical staff to consider delirium risk factors and preventative
strategies
• Lists the components of diagnostic investigation if delirium is suspected
Limitations What are the limitations of the tool/resource? Is the tool/resource difficult to understand
and use? Are instructions provided on how to use the tool/resource? Is the tool/resource
poorly presented (images, colour, font type/ size)? Does the tool/resource use difficult to
understand jargon?
Please state any other known limitations, using dot points:
• The DRA sticker has had limited evaluation
References and Supporting references and associated reading.
further reading
1. Clinical Epidemiology and Health Service Evaluation Unit and Delirium Clinical Guidelines
Expert Working Group. Clinical practice guidelines for the management of delirium in older
people. Victorian Government Department of Human Services, on behalf of the Australian
Health Ministers' Advisory Council (AHMAC), Melbourne. 2006.
http://www.health.vic.gov.au/acute-agedcare/ (accessed 18 February 2008)
2. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the
confusion assessment method. A new method for detection of delirium. Annals of Internal
Medicine, 1990;113(12):941-8.
3. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the
elderly. Age & Ageing, 1972;1(4):233-8.
4. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the
cognitive state of patients for the clinician. Journal of Psychiatric Research, 1975;12(3):189-
98.
Northern Sydney Central Coast Health Service Assessment to be completed on admission, pre &
post op. and when there is a change in behaviour
> 70 yrs Delirium Risk Screen (Modified Inouye) (See: Management of Confusion/Poole’s Algorithm)
Tick & Precipitating factors
Pre morbid risk factors add
score
WARNING: these
Visual impairment (unable to read large print on newspaper with factors increase risk
glasses)
1
• Mechanical restraint
Severe illness (nurses’ opinion including mental Illness or 1 • Malnutrition
depression)
Cognitive impairment AMTS <7/10 or MMSE < 25/30 or • 3 new medications
2 added in 24hrs
past history of memory or cognitive deficit
Dehydration (scanty, concentrated urine; fever, thirst, dry mucous 1 • IDC
membranes or raised creatinine/urea) • Iatrogenic event
Score: 0 = low risk 1-2 = medium risk ≥3 = high risk of delirium Score (procedure, infection,
complication, fall etc)
Delirium Risk Low Med High
If change in behaviour CAM * Medical History Physical Medication Review Bloods MSU
RECOMMENDED (incl. family)
review Exam
INVESTIGATIONS
Delirium diagnosed Yes No
Delirium Prevention And Management Protocol See: Australian guidelines http://www.health.vic.gov.au/acute-agedcare/
Cognition • Establish cognitive baseline Vision & • Clean glasses
AMTS or MMSE Hearing • Working hearing aid
• Completed Communication & Care Drugs • Pharmacy review done
Cues form in bed notes (Poole’s Algorithm) • Use antipsychotics with caution
• Interpreters, language aids • Hypnotics or ETOH withdrawal schedule
• Delirium brochure to family & sitters • Regular pain relief
Hydration, • Review hydration Sleep • Quiet & comfort – usual settling routine
Nutrition & • Review food / dentures • Avoid unnecessary hypnotics
Elimination
• Avoid IDCs & constipation • Offer snacks & avoid caffeine
Mobilisation • Active, early independence – Consult & • Consult Geriatrician
& Activities Monitor • Test & review cognition often
Physiotherapy and Walking Program
Signatures: Med Officer:______________________ Date: ____/____/____ Nursing ______________________Date: ____/____/____
* Confusion Assessment Method (CAM) = Delirium diagnostic tool (Inouye et al. 1990 Annals of Internal Medicine. 113:941)
FEB08 CATALOGUE NO:09631
Northern Sydney Central Coast Health Service Assessment to be completed on admission, pre &
post op. and when there is a change in behaviour
> 70 yrs Delirium Risk Screen (Modified Inouye) (See: Management of Confusion/Poole’s Algorithm)
Tick & Precipitating factors
Pre morbid risk factors add
score
WARNING: these
Visual impairment (unable to read large print on newspaper with factors increase risk
glasses)
1
• Mechanical restraint
Severe illness (nurses’ opinion including mental Illness or 1 • Malnutrition
depression)
Cognitive impairment AMTS <7/10 or MMSE < 25/30 or • 3 new medications
2 added in 24hrs
past history of memory or cognitive deficit
Dehydration (scanty, concentrated urine; fever, thirst, dry mucous 1 • IDC
membranes or raised creatinine/urea) • Iatrogenic event
Score: 0 = low risk 1-2 = medium risk ≥3 = high risk of delirium Score (procedure, infection,
complication, fall etc)
Delirium Risk Low Med High
If change in behaviour CAM * Medical History Physical Medication Review Bloods MSU
RECOMMENDED (incl. family)
review Exam
INVESTIGATIONS
Delirium diagnosed Yes No
Delirium Prevention And Management Protocol See: Australian guidelines http://www.health.vic.gov.au/acute-agedcare/
Cognition • Establish cognitive baseline Vision & • Clean glasses
AMTS or MMSE Hearing • Working hearing aid
• Completed Communication & Care Drugs • Pharmacy review done
Cues form in bed notes (Poole’s Algorithm) • Use antipsychotics with caution
• Interpreters, language aids • Hypnotics or ETOH withdrawal schedule
• Delirium brochure to family & sitters • Regular pain relief
Hydration, • Review hydration Sleep • Quiet & comfort – usual settling routine
Nutrition & • Review food / dentures • Avoid unnecessary hypnotics
Elimination
• Avoid IDCs & constipation • Offer snacks & avoid caffeine
Mobilisation • Active, early independence – Consult & • Consult Geriatrician
& Activities Monitor • Test & review cognition often
Physiotherapy and Walking Program
Signatures: Med Officer:______________________ Date: ____/____/____ Nursing ______________________Date: ____/____/____
* Confusion Assessment Method (CAM) = Delirium diagnostic tool (Inouye et al. 1990 Annals of Internal Medicine. 113:941)
FEB08 CATALOGUE NO:09631
