Partnering an implementation strategy with a multi-modal education to improve delirium practices.

aimsTo improve assessment of and communication for delirium to 85% of eligible patients and to improve nurses' knowledge of and self-efficacy for delirium.

backgroundDetection and prevention of delirium have become a high priority safety and quality issue globally. However, inadequate screening and objective assessment by nurses remains ongoing problems, often attributed to an inadequate knowledge base.

methodsA repeated cross-sectional audit study, incorporating the 4Es implementation model and a multimodal education program for nurses, was undertaken across four wards of a rural hospital between March 2023 and March 2024. Bimonthly clinical practice audits using a point prevalence approach were undertaken with a pre-determined benchmark of 85%. The 3-module education program (1. Face to face; 2. Self-directed online; 3. Objective Structured Clinical Examination OSCE) was delivered in a new ward every 2 months. Nursing knowledge of (22 items) and self-efficacy (12 items) for delirium practices were collected before the education program (T0), after program (T1) and 6 weeks following program (T2).

results378 patient notes were audited across 7 audits. Practice outcomes for 6 key practices reached and remained at the benchmark over the study period and for three months after. 187 knowledge surveys were submitted by 90 participants across all three time points, with 30 participants submitting all three. 86% were RNs with a mean age of 41.03 and 15.86-years' experience. Knowledge outcomes were satisfactory and remain unchanged over time [T0 16.62 [SD 2.96]; T1 17.07 [SD 2.01]; T2 17.67 [SD 1.62]). Participant self-efficacy for detection and management of delirium improved significantly between T0 and T2. Participant feedback indicated that the education program, especially module 3-OSCE, contributed significantly to this self-efficacy

conclusionThis study demonstrated that pairing an evidence-based education program with an implementation strategy created synergies that led to sustainable improvements in key delirium assessment and communication practices. Nursing leaders, including nursing managers, nurse educators, and specialised expert nurses, play an integral role in ensuring successful translation of research into practice and quality improvement projects. For such projects to be successful, nurse managers need to be highly visible to legitimise the project and implementation team and to facilitate processes. CLINICAL TRIAL NUMBER: Not applicable.