Background 

Delirium is a distressing acute neurocognitive condition experienced by around one-third of patients in inpatient palliative care units (PCUs). Proactive systems for evidence-based delirium care are missing and innovation is needed. 

 

Aim  

To develop a patient-centred delirium monitoring system in PCUs to improve delirium prevention, detection, root cause treatment, and clinical responses to patients’ distress by integrating Palliative Care Outcomes Collaboration (PCOC) and the Delirium Clinical Care Standard. 

 

Methods 

The ‘MODEL-PC study’ is an exploratory sequential mixed methods project (2022-23). Through consultation with patients, family carers, staff of four Australian PCUs and other stakeholders, a new delirium monitoring system will be developed (stage 1) and then piloted (stage 2). Data collection is via process mapping, clinical audits, semi-structured interviews, and case report forms aligned with PCOC methods. Quantitative, qualitative, and mixed methods analyses will determine a range of implementation, process, and patient outcomes, including the systemic utility (overall feasibility, acceptability, and appropriateness) of the new system for wider testing.

 Results

At abstract submission, preliminary stage 1 results include 111 baseline audits of discharged patients’ medical records (40 (36%) female, mean (±SD) age 76.2 (±13.8) years, 18.9% preferred language not English). Three-quarters (74.8%) died during admission and 31.5% experienced delirium. Of the eight Delirium Standard quality statements, only standard 1 (screening for cognitive impairment on admission, 71.2%) and 6 (risk assessment for hospital complications, 68.6%) were achieved. Preventive strategies, patient-centred information and support, and avoidance of both antipsychotics and benzodiazepines for delirium were rarely demonstrated (7.2%, 20% and 14%, respectively). 

 

Preliminary results confirm the need for quality improvement in delirium care in PCUs and the importance of obtaining patients’ perspectives about care. Full stage 1 results (including the new delirium monitoring system to be piloted) of the MODEL-PC study will be presented at the OPCC conference.