Reducing harm for people displaying symptoms associated with a neurocognitive disorder (delirium or dementia)

People experiencing behavioural and psychological symptoms (BPS) related to a neurocognitive disorder like dementia or delirium are at high risk of experiencing preventable harm during their hospital admission.

This study, funded by the Dementia Centre for Research Collaboration, aimed to understand the acceptability and feasibility of a strategy to increase nurses’ uptake of best practice guidelines in relation to people displaying BPS associated with a neurocognitive disorder.

“Despite strong evidence that individually tailored, non-pharmacological interventions can reduce symptoms and prevent harm, care delivered in hospitals is frequently inconsistent with best practice,” says Alfred Deakin Professor Alison Hutchinson, Director of the Institute’s Centre for Quality and Patient Safety Research (QPS).

The objectives were to co-produce a three-part knowledge translation strategy – facilitation, education, and a decision-support tool – to improve nurses’ understanding of neurocognitive disorders and support them in translating their knowledge in patient care. The researchers then evaluated the acceptability of the strategy to nurses on the ward, and the feasibility for its use in acute hospital settings.

The decision-support tool was integrated into an app called BRAIN-TRK and was co-developed with experts, nurse end-users and a consumer over three months. BRAIN-TRK included three components: cognition and risk assessment; tailored evidence-based strategies; and monitoring and evaluation of effectiveness.

Over 170 hours of observations of the care provided to patients with BPS showed that the number of best practice interventions used by nurses increased from a median of one pre-intervention to four post-intervention. The average number of medication errors and falls per month, measured before and during the study period also decreased by 26.8% and 5.8%, respectively.

“The intervention showed it has the potential to improve nurses’ knowledge and use of best-practice interventions when caring for patients displaying BPS related to a neurocognitive disorder and we believe future research is warranted to refine the strategy, and test its impact and sustainability,” says Professor Hutchinson.

Members of the research team include Alfred Deakin Professor Alison Hutchinson, Associate Professor Bernice Redley, Professor Tracey Bucknall, Dr Helen Rawson and Dr Emily Tomlinson from the Centre for Quality and Patient Safety and colleagues from Cairnmillar Institute, Monash Health, Monash University and University of Manitoba, Canada.