A Standardized, Bundled Approach to Providing Geriatric‐Focused Acute Care. Issue 5 (18th April 2014)

• Record Type: Journal Article
• Authors: Mattison, Melissa L. P.; Catic, Angela; Davis, Roger B.; Olveczky, Daniele; Moran, Julie; Yang, Julius; Aronson, Mark; Zeidel, Mark; Lipsitz, Lewis; Marcantonio, Edward R.
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 5(2014:May)
• Page Start: 936
• Page End: 942
• Publication Date: 2014-04-18
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12780
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12780-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12780-sec-0001" sec-type="section"> <title>Objectives</title> <p>To determine whether a bundled intervention can increase detection of delirium and facilitate safer use of high‐risk medications.</p> </sec> <sec id="jgs12780-sec-0002" sec-type="section"> <title>Design</title> <p>Pre‐post interventional trial.</p> </sec> <sec id="jgs12780-sec-0003" sec-type="section"> <title>Setting</title> <p>Large academic medical center.</p> </sec> <sec id="jgs12780-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals aged 70 and older (n = 19, 949) admitted between May 1, 2008, September 30, 2011. Individuals aged 80 and older admitted after April 26, 2010, received the intervention, those aged 80 and older admitted before were primary controls, and those aged 70 to 79 were concurrent controls.</p> </sec> <sec id="jgs12780-sec-0005" sec-type="section"> <title>Intervention</title> <p>The intervention uses a checklist promoting delirium prevention, recognition and management, and modifies the computerized provider order entry system to provide care focused on elderly adults.</p> </sec> <sec id="jgs12780-sec-0006" sec-type="section"> <title>Measurements</title> <p>Frequency of orders for activating the rapid response team for altered mental status, frequency of orders for haloperidol in excess of 0.5 mg or intravenous (IV) morphine in excess of 2 mg, and discharge disposition.</p> </sec> <sec id="jgs12780-sec-0007" sec-type="section"> <title>Results</title> <p>Participants receiving the intervention had a mean age of 86.1 ± 4.6; 58.2% were female. The number of orders to activate the rapid response team for altered mental status increased in participants receiving the bundle and in controls (odds ratio (OR) for the difference of differences = 1.23 (95% confidence interval (CI) = 0.68–2.24, <italic>P</italic> = .49)). Participants receiving the bundle were less likely to receive more than 0.5 mg of IV, intramuscular, or oral haloperidol (OR = 0.60, 95% CI = 0.39–0.91, <italic>P</italic> = .02) and more than 2 mg of IV morphine (OR = 0.52, 95% CI = 0.42–0.63, <italic>P</italic> < .001). Participants who received the bundle were more likely to be discharged home than to extended care facilities (OR = 1.18, 95% CI = 1.04–1.35, <italic>P</italic> = .01).</p> </sec> <sec id="jgs12780-sec-0008" sec-type="section"> <title>Conclusion</title> <p>An intervention focused on delirium prevention and recognition by bedside staff combined with computerized decision support facilitates safer prescribing of high‐risk medications and possibly results in less need for extended care.</p> </sec> </abstract>