title: Effects of an interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) on nursing workload: a pilot study.
abstract: BACKGROUND
  Delirium in elderly hip-fracture patients is common and results in negative patient outcomes and increased nursing workload.
  
  
  OBJECTIVE
  The study was part of an evaluation of the interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) in a Swiss university hospital. Nursing workload was compared before and after implementing the program, using a quasi-experimental design.
  
  
  METHODS
  Included were 200 patients who were 65 years of age or older, recovering from hip-fracture surgery on a trauma ward (intervention) or on the other surgery wards.
  
  
  METHODS
  Workload was compared before and after implementing the program on the trauma ward and was also compared on other surgery wards. Nursing workload for each patient was evaluated by means of data obtained from the nursing workload management system. Data were collected in a 4-month timeframe in 2004 and 2005 respectively. Differences for workload in total and workload for day, evening, and night shifts on postoperative days 1-5 were calculated, controlled by co-morbidity. Subgroup analysis was performed for patients categorized by nurses as 'confused'.
  
  
  RESULTS
  Total workload decreased slightly from Year 1 to 2 by 6.4% and 4.2% for patients on the trauma ward and other surgery wards. However, workload during night shifts on the trauma ward decreased significantly by 22% (p=.004), while there was not a significant change on the other surgery wards. Sub-analyses for 'confused' patients found that the workload at night on the trauma ward decreased significantly by 23% (p=.01), while it did not change significantly on other surgery wards. Higher co-morbidity and nurses' labelling patients as 'confused' were associated with increased workload (p<.001).
  
  
  CONCLUSIONS
  After implementing the program, decreased workload at night was found on the trauma ward. Delirium was detected and treated more quickly which led to less care needed at night. The reason for the slight drop in workload on all wards requires further investigation.
authors.affiliation: Department of Clinical Nursing Science, University Hospital Basel, Basel, Switzerland. mpretto@uhbs.ch
authors.forename: Manuela
authors.initials: M
authors.lastname: Pretto
authors.forename: Rebecca
authors.initials: R
authors.lastname: Spirig
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
authors.forename: Sabina
authors.initials: S
authors.lastname: Degeest
authors.forename: Pietro
authors.initials: P
authors.lastname: Regazzoni
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hasemann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006620:Hip Fractures / Q000150:complications; D006801:Humans; D008297:Male; D009729:Nursing; D010865:Pilot Projects; D016526:Workload