{
  "abstract": "Background Delirium is prevalent in hospice inpatient units (IPUs) (Watt, Momoli, Ansari, et al. Palliat Med. 2019;33(8):865-877), causing distress for patients and families and resulting in high care burden for staff (Rainsford, Rosenberg, Bullen. J Palliat Med. 2014;17(9):1045-8). However, delirium is often poorly recognised and managed (Hosie, Davidson, Agar, et al. Palliat Med. 2013;27(6):486-98). In 2021 a Delirium Toolkit was developed to support the detection and management of delirium among patients in three hospice IPUs. The Toolkit consisted of a ‘step-by-step’ checklist, a patient information leaflet; non-pharmacological checklist; 4AT tool and a ‘getting to know you’ form. The Toolkit was appraised through a retrospective service evaluation looking at its implementation into practice.Aim To establish if the implementation of a Delirium Toolkit has improved the recognition and management of delirium in hospice IPUs.Method A staff survey was developed using ‘normalisation process theory’ (Finch, Girling, May, et al. BMC Med Res Methodol. 2018 Nov 15;18(1):135) to test how embedded the Toolkit was in practice (n=54). Patient record data (n=399) was analysed before and after implementation to measure the impact on the incidence of delirium. In-depth interviews were conducted with four hospice staff exploring the practical application and deeper understanding of the Toolkit.Results The presence of delirium decreased following the introduction of the Toolkit (87% before; 74% after). Staff were positive about the contribution of all elements of the Toolkit and saw it as beneficial. Embedding the Toolkit was not consistent across the organisation. Some staff felt very familiar and confident in its use but not others, which varied by profession and relevance to practice. Staff were less confident in identifying hypo-delirium than they were hyper-delirium. Further training was suggested and has started to help overcome these barriers.Conclusion Support was high for the Toolkit and offers a complete package of tools and a sequential process to support the detection and management of delirium in hospice inpatients. Implementation of a similar approach is recommended in other hospice settings, with appropriate training and leadership.",
  "authors": [
    {
      "affiliations": [
        "Pilgrims Hospices in East Kent, Canterbury, UK"
      ],
      "name": "Amanda Timms"
    },
    {
      "affiliations": [
        "Pilgrims Hospices in East Kent, Canterbury, UK"
      ],
      "name": "Charlotte Brigden"
    },
    {
      "affiliations": [
        "Pilgrims Hospices in East Kent, Canterbury, UK"
      ],
      "name": "Justine Robinson"
    },
    {
      "affiliations": [
        "Pilgrims Hospices in East Kent, Canterbury, UK"
      ],
      "name": "Ellie Timms"
    }
  ],
  "title": "P-71 Evaluation of a toolkit to support the detection and management of delirium in hospice inpatients",
  "uid": "a0c19ccd-a531-51f3-a708-85a12d93f100"
}