Authors (including presenting author) :
Li TW(1), Fung MK(2), Sin PS(2), Nguyen TAV(3), Siu YP(3), Tsang TC(3), Wong KY(3)
Affiliation :
(1)Department of Nursing, Hong Kong Buddhist Hospital, (2) Department of Nursing, Kowloon Hospital, (3) Department of Nursing, Queen Elizabeth Hospital
Introduction :
Fragility hip fracture(FHF) patients were found at high risk of perioperative delirium(nearly 50%) with longer hospital stay and higher cost. To conduct the screening intervention of delirium risk, 4AT assessment tool(Alertness, AMT4(age, date of birth, place and current year), Attention and Acute change or fluctuating course) could be used because of its high validity and reliability. The aim of this study was to investigate the effectiveness of delirium care bundle with 4AT assessment tool on FHF patients.
Objectives :
(1)Investigate the compliance of assessment and special care bundles in a ward specialized in FHF; (2)Evaluate the effectiveness of delirium care bundle with 4AT assessment tool on FHF patients.
Methodology :
A quantitative observational study was conducted in Queen Elizabeth Hospital(QEH). A group of patients under “special care bundle” in a ward specialized in FHF, were compared with another group of patients under “routine care” in general orthopedic ward. The “special care bundle” included prevention and intervention cares. The preventive care included on-going delirium assessment, environment control, physical care and cognitive orientation. When high risk of delirium(4AT score at least 4) was found, an algorithm was used to rule out the cause of delirium, reinforce patient orientation regularly and enhance family support and involvement.
The selected patients met all the inclusion criteria: (1)FHF diagnosed, (2)operation day 0-4, (3)age at least 65 and (4)communicable; Exclusion criteria: (1)dementia, (2)transfer case from other wards/hospital. At least 87 patients were selected to detect the effectiveness of the care bundles(power 0.8; alpha 0.05; effect size 0.3).
Result & Outcome :
(1)Good compliance of 4AT assessment and care bundles were done in “special care bundle” group(audit 50 patients, compliance rate: 100%). (2)The “special care bundle” was found effective in controlling the risk of delirium. The percentage of high-risk delirium in “special care bundle” group(4%) was much lower than in “routine care” group(16%) with significant difference(p-value 0.046). The risk of delirium rate was significantly reduced in “special care bundle” group, which proved that delirium was effectively preventable by the “special care bundle” with 4AT screening tool. Therefore, launch the care bundles based on 4AT score in all FHF cases was recommended.
