Modifying the Inpatient Environment to Reduce the Incidence and Burden of Delirium Among Hospitalized Older Adults (≥70 Years).
Farhaan S. Vahidy
Summary
The overall goal is to reduce the incidence and burden of delirium, as measured by the delirium burden index (DBI) among hospitalized older adults (≥70 years), by modifying the inpatient environment to decrease its sleep antagonism. The investigators propose to implement a multi-modal sleep hygiene (MMSH) bundle, an enhancement of a previously reported sleep-focused intervention which had 88 - 100% compliance for intervention components, and reduced ICU delirium by 50%.
Description
The Investigators will implement the MMSH in a randomized step-wedge cluster design across 11 independent nursing units of 4 Methodist hospitals. While primarily focusing on the MMSH effectiveness, the investigators will conduct process evaluation to identify barriers and facilitators for MMSH implementation. Specific Aim 1: Establish the comparative effectiveness of an in-hospital, MMSH towards reducing the rate of incident (hospital acquired) delirium (HAD) among older adults (age ≥ 70). The investigators will compare the rate of incident delirium between patients receiving the MMSH bundle…
Eligibility
- Age range
- 70+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion criteria: * Non-critically ill patients (≥70 years) * All sexes * All races and ethnicities * Admitted to the pre-specified clinical units which are part of the study Exclusion criteria (applied during analysis): * Patients with active alcohol or substance withdrawal. * Patients with acute psychiatric illness * Patients with initial admission to intensive care unit including requirement for mechanical ventilation. * Patients present on a unit at the time of unit randomization
Interventions
- OtherMMSH (Multi-Modal Sleep Hygiene) Bundle
Focus on Noise Reduce Noise Perception, Reduce Hallway Noise, Reduce Noise in Rooms Focus on Light Reduce Lights at Night, Increase Light in Day, Reduce Light Perception Focus on Staff-Patient Interactions Delirium Screening, Avoid Care Procedures at Night, Z-time Plan \& Prep Focus on Daytime Activity Increased Mobility, Increase Patient Engagement Focus on Medications Pain Management, Medication Monitoring, Continue pharmacy protocols, Timing of Medications/Monitoring Labs
Locations (5)
- Houston Methodist Baytown HospitalBaytown, Texas
- Houston Methodist HospitalHouston, Texas
- Houston Methodist Research InstituteHouston, Texas
- Houston Methodist West HospitalHouston, Texas
- Houston Methodist Sugarland HospitalSugarland, Texas