title: Evaluation of the delirium early monitoring system (DEMS).
abstract: Despite awareness of the negative health and financial outcomes of delirium, systems to routinely assess and manage the condition are absent in clinical practice. We report the development and pilot evaluation of a Delirium Early Monitoring System (DEMS), designed to be completed by non-medical staff to influence clinical processes within inpatient settings. Two versions of the DEMS are described based on a modified Confusion Assessment Method (DEMS-CAM) and Delirium Observation Screening Scale (DEMS-DOSS).
  
  
  
  Both versions of DEMS were piloted on a 20-bedded Psychogeriatric ward over 6 weeks. Training was administered to ward staff on the use of each version of the DEMS and data were collected via electronic medical records and completed assessment sheets. The primary outcome was patterns of DEMS use and the secondary outcome was the initiation of delirium management protocols. Data regarding the use of the DEMS DOSS and DEMS CAMS were analyzed using χ 2 tests.
  
  
  
  Completion rates for the DEMS CAM and DEMS DOSS were 79% and 68%, respectively. Non-medical staff were significantly more likely to use the DEMS-CAM as part of daily practice as opposed to the DEMS-DOSS (p<0.001). However, there was no difference between the use of the DEMS-CAM and DEMS-DOSS in triggering related actions such as documentation of assessment scores in patients' medical records and implementation of delirium management protocols.
  
  
  
  This real world evaluation revealed that non-medical staff were able to incorporate delirium monitoring into their practice, on the majority of occasions, as part of their daily working routine. Further research is necessary to determine if the routine use of the DEMS can lead to improved understandings and practice of non-medical staff regarding delirium detection.
authors.affiliation: Northumberland,Tyne and Wear NHS Foundation Trust,Newcastle upon Tyne,UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rippon
authors.affiliation: Department of Public Health and Primary Care,Academic Centre for Nursing and Midwifery,KU Leuven,Leuven,Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
authors.affiliation: Department of Public Health and Primary Care,Academic Centre for Nursing and Midwifery,KU Leuven,Leuven,Belgium.
authors.forename: Elke
authors.initials: E
authors.lastname: Detroyer
authors.affiliation: Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK.
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Mukaetova-Ladinska
authors.affiliation: Northumberland,Tyne and Wear NHS Foundation Trust,Newcastle upon Tyne,UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Harrison
authors.affiliation: University Medical Centre Utrecht,Utrecht,the Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Schuurmans
authors.affiliation: Northumberland,Tyne and Wear NHS Foundation Trust,Newcastle upon Tyne,UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Pryor
authors.affiliation: Northumberland,Tyne and Wear NHS Foundation Trust,Newcastle upon Tyne,UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Teodorczuk
mesh_terms: D000368:Aged; D000488:Allied Health Personnel / Q000458:organization & administration / Q000592:standards; D000067289:Behavior Observation Techniques / Q000379:methods*; D003221:Confusion / Q000175:diagnosis* / Q000209:etiology; D003693:Delirium / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D042241:Early Diagnosis; D004739:England; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008501:Medical Records, Problem-Oriented / Q000592:standards; D008991:Monitoring, Physiologic / Q000379:methods; D015397:Program Evaluation; D058996:Quality Improvement; D063189:Symptom Assessment / Q000379:methods
keywords: delirium; dementia; detection; education; practice