title: An evolving approach to delirium: A mixed-methods process evaluation of a hospital-wide delirium program in New Zealand.
abstract: OBJECTIVE
  A process evaluation was carried out to assess and potentially improve the design and implementation of a hospital-wide delirium program.
  
  
  METHODS
  A mixed-methods sequential-explanatory design was used; retrospective chart reviews for 100 older (75+) medical inpatients were conducted to measure nurses', doctors' and coders' adherence to key program processes following which interviews were conducted to identify potential barriers to implementation.
  
  
  RESULTS
  Delirium occurred in 49% of patients. Chart reviews revealed suboptimal adherence to the delirium risk assessment (66%), the Short Confusion Assessment Method (50% on admission, 58% during admission), documentation of delirium in clinical records (80%) and discharge letters (38%) and coding for delirium (49%). The major barriers to implementation identified were failure to recruit non-nursing staff, unclear goals and instructions, difficulties using the Short-CAM, time constraints with competing priorities and lack of outcome expectancy.
  
  
  CONCLUSIONS
  A new delirium program was needed based on these findings.
authors.affiliation: Department of General Medicine, Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Abdullah Ao
authors.identifier: http://orcid.org/0000-0002-3617-2299
authors.initials: AA
authors.lastname: Alhaidari
authors.affiliation: Department of General Medicine, Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Rosalind Ac
authors.initials: RA
authors.lastname: Allen-Narker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: New Zealand; critical pathway; delirium; program development; program evaluation