Randomized trial of a delirium abatement program for postacute skilled nursing facilities

Abstract

Objectives: To determine whether a delirium abatement program (DAP) can shorten duration of delirium in new admissions to postacute care (PAC).

Design: Cluster randomized controlled trial.

Setting: Eight skilled nursing facilities specializing in PAC within a single metropolitan region.

Participants: Four hundred fifty-seven participants with delirium at PAC admission.

Intervention: The DAP consisted of four steps: assessment for delirium within 5 days of PAC admission, assessment and correction of common reversible causes of delirium, prevention of complications of delirium, and restoration of function.

Measurements: Trained researchers screened eligible patients. Those with delirium defined according to the Confusion Assessment Method were eligible for participation using proxy consent. Regardless of location, researchers blind to intervention status re-assessed participants for delirium 2 weeks and 1 month after enrollment.

Results: Nurses at DAP sites detected delirium in 41% of participants, versus 12% in usual care sites (P<.001), and completed DAP documentation in most participants in whom delirium was detected, but the DAP intervention had no effect on delirium persistence based on two measurements at 2 weeks (DAP 68% vs usual care 66%) and 1 month (DAP 60% vs usual care 51%) (adjusted P> or =.20). Adjusting for baseline differences between DAP and usual care participants and restricting analysis to DAP participants in whom delirium was detected did not alter the results.

Conclusion: Detection of delirium improved at the DAP sites, but the DAP had no effect on the persistence of delirium. This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities.

Trial registration: ClinicalTrials.gov NCT00182936.

Figure 1. CONSORT Figure for Randomized Trial

This figure describes facility randomization and the screening, enrollment, randomization, and follow-up process for participants in the clinical trial. Facilities were matched based on ownership status (profit vs. non-profit), size, and setting (urban vs. suburban).