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Supportive Care in Cancer

, Volume 27, Issue 2, pp 557–565 | Cite as

Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial

  • Asao OgawaEmail author
  • Yasuyuki Okumura
  • Daisuke Fujisawa
  • Hiroyuki Takei
  • Chiyuki Sasaki
  • Kei Hirai
  • Yusuke Kanno
  • Kensuke Higa
  • Yasuhiko Ichida
  • Asuko Sekimoto
  • Chie Asanuma
Original Article

Abstract

Background

We evaluated whether the DELirium Team Approach (DELTA) program—a systematic management program aimed at screening high-risk groups and preventing delirium—would improve quality of care in patients hospitalized with cancer.

Methods

A retrospective before–after study was conducted during a pre-intervention period (between October 2012 and March 2013) and a post-intervention period (between October 2013 and March 2014) at a Japanese hospital providing specialized treatments for cancer. A total of 4180 inpatients were evaluated before the implementation of the DELTA program and 3797 inpatients were evaluated after implementation.

Results

After program implementation, the incidence of delirium decreased from 7.1 to 4.3% (odds ratio [OR], 0.52; 95% CI, 0.42–0.64). The incidence of adverse events, including falls or self-extubation, also decreased, from 3.5 to 2.6% (OR, 0.71; 95% CI, 0.54–0.92). There was a significant decrease in the prescription of benzodiazepines (OR, 0.79; 95% CI, 0.71–0.87), increase in the level of independence in activities of daily living at discharge (OR, 1.94; 95% CI, 1.11–3.38), and decrease in the length of stay (risk ratio 0.90; 95% CI, 0.90–0.90).

Conclusions

The systematic management program for delirium decreased the incidence of delirium and improved several clinical outcomes. These data suggest that this simple cost-effective program is feasible and implementable as routine care in busy wards.

Keywords

Cancer Cognitive impairment Delirium Education program Prevention 

Notes

Acknowledgments

We are grateful to the staff who assisted in the program management, including Ms. Junko Ueda, Ms. Tomoko Nishimura, Dr. Hiroyuki Nobata, Dr. Yoshio Iwata, Ms. Yasuko Uchimura, and Ms. Kana Toyonaga, and to the staff in the Department of Nursing at the National Cancer Center Hospital East.

Funding information

This work was supported by the National Cancer Center Research and Development Fund and by Japan Agency for Medical Research and Development Grants for Practical Research for Innovative Cancer Control, Grant Number 16ck0106216h0001.

Compliance with ethical standards

Research ethics and patient consent

This study was conducted in accordance with the amended Declaration of Helsinki and was approved by the Ethical Committee of the National Cancer Center, Japan (2014-028, approval no.: 2014-028). The full protocol is available from the corresponding author.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Akunne A, Murthy L, Young J (2012) Cost-effectiveness of multi-component interventions to prevent delirium in older people admitted to medical wards. Age Ageing 41:285–291CrossRefGoogle Scholar
  2. 2.
    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424CrossRefGoogle Scholar
  3. 3.
    Barker AL, Morello RT, Wolfe R, Brand CA, Haines TP, Hill KD, Brauer SG, Botti M, Cumming RG, Livingston PM, Sherrington C, Zavarsek S, Lindley RI, Kamar J (2016) 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ 352:h6781CrossRefGoogle Scholar
  4. 4.
    Board INC (2011) Report of the International Narcotics Control Board on the availability of internationally controlled drugs: ensuring adequate access for medical and scientific purposes. In: Editor (ed)^(eds) Book Report of the International Narcotics Control Board on the availability of internationally controlled drugs: ensuring adequate access for medical and scientific purposes. International Narcotics Control Board, United Nations, CityGoogle Scholar
  5. 5.
    Breitbart W, Marotta R, Platt MM, Weisman H, Derevenco M, Grau C, Corbera K, Raymond S, Lund S, Jacobson P (1996) A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 153:231–237CrossRefGoogle Scholar
  6. 6.
    Centeno C, Sanz A, Bruera E (2004) Delirium in advanced cancer patients. Palliat Med 18:184–194CrossRefGoogle Scholar
  7. 7.
    Coyle MA, Burns P, Traynor V (2017) Is it my job? The role of RNs in the assessment and identification of delirium in hospitalized older adults: an exploratory qualitative study. J Gerontol Nurs 43:29–37CrossRefGoogle Scholar
  8. 8.
    Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y (2001) Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 27:1297–1304CrossRefGoogle Scholar
  9. 9.
    Excellence NIfHaC (2010) Delirium: prevention, diagnosis and management. In: editor (ed)^(eds) Book delirium: prevention, diagnosis and management, CityGoogle Scholar
  10. 10.
    Gagnon P, Allard P, Gagnon B, Merette C, Tardif F (2012) Delirium prevention in terminal cancer: assessment of a multicomponent intervention. Psychooncology 21:187–194CrossRefGoogle Scholar
  11. 11.
    Gamberini M, Bolliger D, Lurati Buse GA, Burkhart CS, Grapow M, Gagneux A, Filipovic M, Seeberger MD, Pargger H, Siegemund M, Carrel T, Seiler WO, Berres M, Strebel SP, Monsch AU, Steiner LA (2009) Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery—a randomized controlled trial. Crit Care Med 37:1762–1768CrossRefGoogle Scholar
  12. 12.
    Girard TD, Pandharipande PP, Carson SS, Schmidt GA, Wright PE, Canonico AE, Pun BT, Thompson JL, Shintani AK, Meltzer HY, Bernard GR, Dittus RS, Ely EW, Investigators MT (2010) Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med 38:428–437CrossRefGoogle Scholar
  13. 13.
    Gurlit S, Mollmann M (2008) How to prevent perioperative delirium in the elderly? Z Gerontol Geriatr 41:447–452CrossRefGoogle Scholar
  14. 14.
    Hakim SM, Othman AI, Naoum DO (2012) Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: a randomized trial. Anesthesiology 116:987–997CrossRefGoogle Scholar
  15. 15.
    Hatta K, Kishi Y, Wada K, Takeuchi T, Odawara T, Usui C, Nakamura H, Group D-J (2014) Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry 71:397–403CrossRefGoogle Scholar
  16. 16.
    Hempenius L, Slaets JP, van Asselt D, de Bock GH, Wiggers T, van Leeuwen BL (2013) Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly cancer patients: report on a multicentre, randomized, controlled trial. PLoS One 8:e64834CrossRefGoogle Scholar
  17. 17.
    Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J (2013) Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliat Med 27:486–498CrossRefGoogle Scholar
  18. 18.
    Hshieh TT, Yue J, Oh E, Puelle M, Dowal S, Travison T, Inouye SK (2015) Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med 175:512–520CrossRefGoogle Scholar
  19. 19.
    Inouye SK (2006) Delirium in older persons. N Engl J Med 354:1157–1165CrossRefGoogle Scholar
  20. 20.
    Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676CrossRefGoogle Scholar
  21. 21.
    Inouye SK, Leo-Summers L, Zhang Y, Bogardus ST Jr, Leslie DL, Agostini JV (2005) A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc 53:312–318CrossRefGoogle Scholar
  22. 22.
    Inouye SK, Brown CJ, Tinetti ME (2009) Medicare nonpayment, hospital falls, and unintended consequences. N Engl J Med 360:2390–2393CrossRefGoogle Scholar
  23. 23.
    Inouye SK, Westendorp RG, Saczynski JS (2014) Delirium in elderly people. Lancet 383:911–922CrossRefGoogle Scholar
  24. 24.
    Kalisvaart KJ, de Jonghe JF, Bogaards MJ, Vreeswijk R, Egberts TC, Burger BJ, Eikelenboom P, van Gool WA (2005) Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 53:1658–1666CrossRefGoogle Scholar
  25. 25.
    Korc-Grodzicki B, Sun SW, Zhou Q, Iasonos A, Lu B, Root JC, Downey RJ, Tew WP (2015) Geriatric assessment as a predictor of delirium and other outcomes in elderly patients with cancer. Ann Surg 261:1085–1090CrossRefGoogle Scholar
  26. 26.
    Lakatos BE, Capasso V, Mitchell MT, Kilroy SM, Lussier-Cushing M, Sumner L, Repper-Delisi J, Kelleher EP, Delisle LA, Cruz C, Stern TA (2009) Falls in the general hospital: association with delirium, advanced age, and specific surgical procedures. Psychosomatics 50:218–226CrossRefGoogle Scholar
  27. 27.
    Larsen KA, Kelly SE, Stern TA, Bode RH Jr, Price LL, Hunter DJ, Gulczynski D, Bierbaum BE, Sweeney GA, Hoikala KA, Cotter JJ, Potter AW (2010) Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 51:409–418CrossRefGoogle Scholar
  28. 28.
    Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK (2008) One-year health care costs associated with delirium in the elderly population. Arch Intern Med 168:27–32CrossRefGoogle Scholar
  29. 29.
    Ljubisavljevic V, Kelly B (2003) Risk factors for development of delirium among oncology patients. Gen Hosp Psychiatry 25:345–352CrossRefGoogle Scholar
  30. 30.
    Long JS (1997) Regression models for categorical and limited dependent variables. Sage, Thousand OaksGoogle Scholar
  31. 31.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index Maryland state medical journal, vol 14, pp 61–65Google Scholar
  32. 32.
    Marcantonio ER, Flacker JM, Wright RJ, Resnick NM (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49:516–522CrossRefGoogle Scholar
  33. 33.
    Martin BJ, Buth KJ, Arora RC, Baskett RJ (2010) Delirium as a predictor of sepsis in post-coronary artery bypass grafting patients: a retrospective cohort study. Crit Care 14:R171CrossRefGoogle Scholar
  34. 34.
    McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E (2002) Delirium predicts 12-month mortality. Arch Intern Med 162:457–463CrossRefGoogle Scholar
  35. 35.
    Ohta T, Waga S, Handa H, Saito I, Takeuchi H, Suzuki J, Takaku A (1974) New grading of level of disordered consciousness (in Japanese) Jpn J Neurosurg 2: 623–627Google Scholar
  36. 36.
    Paulson CM, Monroe T, McDougall GJ Jr, Fick DM (2016) A family-focused delirium educational initiative with practice and research implications. Gerontol Geriatr Educ 37:4–11CrossRefGoogle Scholar
  37. 37.
    Pompei P, Foreman M, Rudberg MA, Inouye SK, Braund V, Cassel CK (1994) Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc 42:809–815CrossRefGoogle Scholar
  38. 38.
    Prakanrattana U, Prapaitrakool S (2007) Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 35:714–719PubMedGoogle Scholar
  39. 39.
    Rice KL, Bennett M, Gomez M, Theall KP, Knight M, Foreman MD (2011) Nurses’ recognition of delirium in the hospitalized older adult. Clin Nurse Spec 25:299–311CrossRefGoogle Scholar
  40. 40.
    Rothschild JM, Bates DW, Leape LL (2000) Preventable medical injuries in older patients. Arch Intern Med 160:2717–2728CrossRefGoogle Scholar
  41. 41.
    Siddiqi N, Cheater F, Collinson M, Farrin A, Forster A, George D, Godfrey M, Graham E, Harrison J, Heaven A, Heudtlass P, Hulme C, Meads D, North C, Sturrock A, Young J (2016) The PiTSTOP study: a feasibility cluster randomized trial of delirium prevention in care homes for older people. Age Ageing 45:652–661PubMedPubMedCentralGoogle Scholar
  42. 42.
    Speed G (2015) The impact of a delirium educational intervention with intensive care unit nurses. Clin Nurse Spec 29:89–94CrossRefGoogle Scholar
  43. 43.
    Sundararajan V, Quan H, Halfon P, Fushimi K, Luthi JC, Burnand B, Ghali WA, International Methodology Consortium for Coded Health I (2007) Cross-national comparative performance of three versions of the ICD-10 Charlson index. Med Care 45:1210–1215CrossRefGoogle Scholar
  44. 44.
    Vasilevskis EE, Han JH, Hughes CG, Ely EW (2012) Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol 26:277–287CrossRefGoogle Scholar
  45. 45.
    Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Asao Ogawa
    • 1
    • 2
    Email author return OK on get
  • Yasuyuki Okumura
    • 3
  • Daisuke Fujisawa
    • 2
    • 4
  • Hiroyuki Takei
    • 5
  • Chiyuki Sasaki
    • 6
  • Kei Hirai
    • 7
  • Yusuke Kanno
    • 1
  • Kensuke Higa
    • 8
  • Yasuhiko Ichida
    • 9
  • Asuko Sekimoto
    • 6
  • Chie Asanuma
    • 6
  1. 1.Psycho-Oncology Division, Exploratory Oncology Research and Clinical Trial CenterNational Cancer CenterKashiwaJapan
  2. 2.Department of Psycho-Oncology ServiceNational Cancer Center Hospital EastKashiwaJapan
  3. 3.Research Department, Institute for Health Economics and PolicyAssociation for Health Economics Research and Social Insurance and WelfareTokyoJapan
  4. 4.Department of NeuropsychiatryKeio University School of MedicineShinjuku-kuJapan
  5. 5.Department of Psycho-OncologyKumamoto Red Cross HospitalKumamotoJapan
  6. 6.Department of NursingNational Cancer Center Hospital EastKashiwaJapan
  7. 7.Research Management and Administration Section, Office of Management and PlanningOsaka UniversityOsakaJapan
  8. 8.Department of Psycho-OncologyKawaguchi Municipal Medical CenterKawaguchiJapan
  9. 9.Department of PharmacyNational Cancer Center Hospital EastKashiwaJapan

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