title: Translating Delirium Prevention Strategies for Elderly Adults with Hip Fracture into Routine Clinical Care: A Pragmatic Clinical Trial.
abstract: OBJECTIVE
  To compare the feasibility (adherence) and effectiveness (prevalence of delirium, length of stay, mortality, discharge site) of delirium-friendly preprinted postoperative orders (PPOs) for individuals with hip fracture, administered by regular orthopedic nurses, with routine postoperative orders.
  
  
  METHODS
  Pragmatic clinical trial to evaluate a quality improvement intervention.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Individuals aged 65 and older admitted for hip fracture repair (N = 283).
  
  
  METHODS
  PPOs with delirium-friendly options and doses for nighttime sedation, analgesia, and nausea and attention to catheter removal and bowel movements.
  
  
  METHODS
  Adherence to PPO was compared with adherence to routine orders. Drug doses were recorded. Presence of delirium was documented using the Confusion Assessment Method and the Mini-Mental State Examination on postoperative Days 1, 3, and 5. Length of stay, discharge site, and in-hospital mortality were recorded.
  
  
  RESULTS
  Orthopedic nurses adhered reasonably well with delirium-friendly PPOs. Of 283 participants, 42% developed postoperative delirium, with significantly less delirium in the intervention group (intervention 33%, control 51%, P = .001). The effect of the intervention was stronger in individuals with preexisting dementia (intervention 60%, control 97%, P < .001). Participants with postoperative delirium had longer hospital stays and were more likely to die or be discharged to a nursing home, but there was no significant between-group difference in these outcomes.
  
  
  CONCLUSIONS
  It is possible to introduce delirium-friendly PPOs into routine post-hip fracture care in a representative elderly population including individuals with dementia. Delirium-friendly PPOs executed by regular nursing staff resulted in a significant reduction in postoperative delirium but no difference in other outcomes.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.|Center for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Halifax, Nova Scotia, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Freter
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.|Center for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Halifax, Nova Scotia, Canada.
authors.forename: Katalin
authors.initials: K
authors.lastname: Koller
authors.affiliation: Division of Orthopedics, Department of Surgery, School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada.|Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunbar
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.|Center for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Halifax, Nova Scotia, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: MacKnight
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.|Center for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Halifax, Nova Scotia, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D003681:Dehydration / Q000517:prevention & control; D003693:Delirium / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D016530:Orthopedic Nursing; D011182:Postoperative Care / Q000451:nursing*; D011183:Postoperative Complications / Q000517:prevention & control*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014196:Trazodone / Q000627:therapeutic use; D014546:Urinary Catheterization / Q000451:nursing
chemical_list: D000700:Analgesics; D018726:Anti-Dyskinesia Agents; D006220:Haloperidol; D054368:Laxatives; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone
keywords: delirium; dementia; hip fracture; knowledge translation