Do patient characteristics influence nursing adherence to a guideline for preventing delirium?

PURPOSE The purpose of this study was to examine if the characteristics of patients influence nursing adherence to a quality improvement guideline. This guideline consists of delirium risk screening and preventive care, including the use of the Delirium Observation Screening Scale (DOSS). DESIGN A retrospective patient record review study was performed in 18 Dutch hospitals that were implementing a quality improvement project regarding delirium care. The records of patients 70 years of age or older were reviewed over an 11-month period. METHODS Patient characteristics, as well as the extent of risk screening and the application of the DOSS within the screened and nonscreened groups, were recorded by experienced research nurses. Characteristics were compared between these groups and within the high-risk group using multilevel logistic regression analysis. FINDINGS A total of 1,881 patient records were analyzed. In 55% of the total sample, a risk screening was conducted, of which 44% were identified as patients with a high risk for delirium. Acute admissions were screened significantly less often. The DOSS was used in 48% of the patients in the high-risk group, but also in 13% of the patients without an identified risk and in 15% of the nonscreened patients. The factors influencing the use of the DOSS in screened and nonscreened patients included age, domestic circumstances, suffering from dementia, and acute admission. In the nonscreened group, comorbidity also showed significance. CONCLUSIONS Patient characteristics influence nursing in preventive delirium care. CLINICAL RELEVANCE The findings can help to improve preventive delirium care by nurses.