Incidence of delirium in an acute geriatric community hospital: an exploratory analysis of an observational cohort study controlled with a meta-analysis of incidences from literature.

Background Delirium in hospitalised older adults is associated with negative health outcomes. Admission to an alternative care setting may lower the incidence of delirium. The Acute Geriatric Community Hospital (AGCH) was recently opened in the Netherlands and uses a multi-component non-pharmacological intervention strategy to prevent delirium. Objective To describe the incidence of delirium found in the AGCH and compare this incidence to a hospital control group found in literature. Design Prospective cohort study; exploratory meta-analysis of proportions. Setting The AGCH is an acute geriatric unit in an intermediate care facility. Participants Patients aged >65 years with acute medical conditions admitted to the AGCH. Methods Delirium assessment using the Confusion Assessment Method (CAM) upon admission and on day one, two and three or until delirium had resolved. Patients charts were reviewed if CAM was missing. In an logistic mixed-effects model, the delirium incidence rate in AGCH was compared to pooled delirium incidence rates from six studies found in a high-quality review. Results 214 patients from the AGCH (mean age 81.9 years, 47% male, 12% with a history of dementia) were included in the analysis. Delirium developed in 8% (18/214) (95% CI [confidence interval] 5-13%) of patients during AGCH admission compared to 16% (95% CI 12-21%) in hospitals. Admission to the AGCH was associated with a decreased delirium incidence rate compared to the hospital control group (OR [odds ratio]= 0.49, 95% CI 0.24-0.98, p-value=0.044). Conclusions The delirium incidence in the AGCH was relatively low compared to those incidences found in general hospitals.

Peningkatan Pemahaman Perawat Pelaksana dalam Penerapan Keselamatan Pasien Melalui Pelatihan Keselamatan Pasien

AbstrakUpaya membangun budaya keselamatan pasien memerlukan komitmen yang dipengaruhi pengetahuan perawat. Tujuan penelitianquasi experiment ini adalah untuk mengetahui pengaruh pelatihan keselamatan pasien terhadap pemahaman perawat pelaksanamengenai penerapan keselamatan pasien. Hasil penelitian pada 83 perawat pelaksana di RS XX (kelompok eksperimen) dan83 perawat pelaksana di RS XY (kelompok kontrol) menunjukkan ada perbedaan yang bermakna pemahaman perawat pelaksanasebelum dan setelah mendapatkan pelatihan pada kelompok eksperimen (p= 0,000; α= 0,05) dan tidak ada perbedaan padapemahaman perawat pelaksana sebelum dan setelah pada kelompok kontrol (p= 0,417; α= 0,05). Rumah sakit perlu melakukanprogram pelatihan keselamatan pasien secara berkelanjutan dan mengembangkan standar kinerja untuk memfasilitasi transferpengetahuan perawat.Kata Kunci: keselamatan pasien, pelatihan, pemahaman, perawat pelaksanaAbstractEfforts to build a culture of patient safety required commitment is influenced by knowledge of nurses. This quasi-experimentalstudy aimed to describe the influence of patient safety training for nursing staff’s comprehension of the implementation ofpatient safety’s procedure. Results for 83 nursing staffs XX Hospital (experimental group) and 83 nursing staffs XY Hospital(control group) showed no significant differences in understanding nursing staffs before and after receiving training in theexperimental group (p= 0.000; α= 0.05) and no difference in understanding nursing staffs before and after in the controlgroup (p= 0.417; α= 0.05). Hospitals need to make patient safety training program on an ongoing basis and develop performancestandards as a facilitation of transferred of nursing staff’s knowledge.Keywords: comprehension, nursing staffs, patient safety, training