Dr Annmarie Hosie1, Dr Nameer van Oosterom1, Ms Kimberley Campbell3, Mr Prince Peprah1
1University of Notre Dame Australia, Darlinghurst, Australia, 2St Vincent's Health Network Sydney, Darlinghurst, Australia, 3IMPACCT, University of Technology Sydney, Ultimo, Australia
Biography:
Dr Annmarie Hosie is an academic researcher with a focus on improving the care, function and quality of life of people with advanced illness.
She and the project team would like to acknowledge all other MODEL-PC study investigators:
Prof Meera R Agar; Dr Grace Walpole; Dr Paula Moffat; Dr Keiron Bradley; Ms Penelope Casey; Dr Felicity Hawkins; Prof Claire Johnson; Prof Angus Cook; Prof Richard Chye; Dr Jacqueline Oehme; Ms Maria Senatore; Dr Claudia Virdun; Dr Mark Pearson; Ms Imogen Featherstone; Prof Peter Lawlor; Associate Prof Shirley H. Bush; Assoc Prof Barb Daveson; Mrs Sabina Clapham
Abstract:
Background: Delirium is a serious and common condition in palliative care units (PCUs). Proactive systems for evidence-based delirium care are missing and innovation is needed.
Aim: To develop and pilot a new delirium monitoring system in PCUs that integrates perspectives of patients, carers and staff, the Delirium Clinical Care Standard, and Palliative Care Outcomes Collaboration (PCOC) methods.
Methods: The ‘MODEL-PC study’ is an exploratory sequential mixed methods project. In 2023, baseline (stage 1) data aligned with the Delirium Standard were collected at four Australian PCUs, via clinical audits, process mapping, and Critical Incident Technique interviews with patients, carers and staff. Analyses were quantitative, qualitative, and mixed.
Results: Audits examined medical records of 240 patients (75% died during admission, 50% experienced delirium). A third of Delirium Standard quality indicators were achieved for 80% of patients. The only patient variable associated with quality indicators was mortality: compared to discharged patients, those who died had lower likelihood of avoiding benzodiazepines or combined antipsychotics/benzodiazepines during delirium. Process mapping (34 staff) found quality indicators about delirium policy were achieved, while processes and patient measures largely were not. Interviews (16 patients, 17 carers, 41 staff) found ‘patient-centred information and support’ to be the predominant action with a positive outcome.
Conclusion: Participating PCUs met Delirium Standard quality indicators for policy, risk assessment and screening, and low re-admission for delirium. Whereas quality indicators for delirium prevention, assessment, treatment of causes, avoidance of antipsychotics and benzodiazepines, and discharge planning were not met. Of note, although patient-centred information and support were documented in only 20% of medical records, interviews findings suggested that when this aspect of delirium care occurred, it was highly valued.
Stage 2 of the MODEL-PC study is underway and involves new delirium monitoring via PCOC and other strategies to meet the Delirium Standard, with dissemination in 2025.