A Nurse-Initiated Protocol for Interprofessional Management of Changed Behaviours in Hospital Patients With Dementia and/or Delirium: A Modified e-Delphi Study.

AIM

To develop a nurse-initiated protocol for early ward-based interprofessional coordination and formulation of person-centred care plans to assist in point-of-care management of behaviour in older patients on general hospital wards.

DESIGN

A modified e-Delphi method was employed to establish expert consensus.

METHOD

Multidisciplinary acute-care experts experienced in hospital care of patients with dementia and/or delirium in Australia were recruited by email from 35 professional networks. Three online survey rounds were planned. The first sought free-text comments on point-of-care practices. The following rounds sought expert ratings for subsequently developed protocol components. The study occurred between January and June 2023.

RESULTS

Fifty-three experts participated (eight completed all rounds). Existing practices, opportunities and barriers were established in round one (n = 32), informing development of three multicomponent stages: (1) a bundle of bedside care comprising generic person-centred approaches, (2) a stepped-care workflow redirecting multidisciplinary teams to adopt an interprofessional approach to formulating individualised behavioural-care and (3) a one-page Behaviour Support Plan template. Content Validity Index scores for all items in round two (n = 29) were 0.89-0.96, meeting a priori consensus criteria, and negating the need for a third round.

CONCLUSION

To improve outcomes for older hospital patients with changed behaviours, a multicomponent protocol for timely interprofessional formulation of point-of-care Behaviour Support Plans was established through expert panel consensus.

IMPACT

Management of patient behaviours has resided almost solely with nursing, ignoring the potential inherent in ward-based multidisciplinary teams. A pragmatic procedure for initiating early interprofessional support to nurses' management of behaviours may potentially improve care, safety and outcomes for patients and staff alike. Ready for feasibility testing in hospitals, the protocol capitalises on existing multidisciplinary resources.

REPORTING METHOD

The study is reported in accordance with the Guidance on Conducting and Reporting Delphi Studies (CREDES) recommendations.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.