The online version of this article (doi:10.1186/1471-2318-14-69) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
CW, ML, and LS collectively developed the study design. CW conceived of the study, and led the application for current funding through the Dutch Ministry of Health, Welfare and Sport. LS and RI were involved in the acquisition of data. LS did most of the analyses and wrote the first draft and final revision of this manuscript. CW, ML and RI reviewed the manuscript and provided input into initial and final revisions. All authors read and approved the final manuscript.
Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes. Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care. The objective of the study was to determine whether e-learning can be an effective means of improving implementation of a quality improvement project in delirium care. This project aims primarily at improving the early recognition of older patients who are at risk of delirium.
In a stepped wedge cluster randomised trial an e-learning course on delirium was introduced, aimed at nursing staff. The trial was conducted on general medical and surgical wards from 18 Dutch hospitals. The primary outcome measure was the delirium risk screening conducted by nursing staff, measured through monthly patient record reviews. Patient records from patients aged 70 and over admitted onto wards participating in the study were used for data collection. Data was also collected on the level of delirium knowledge of these wards’ nursing staff.
Records from 1,862 older patients were included during the control phase and from 1,411 patients during the intervention phase. The e-learning course on delirium had a significant positive effect on the risk screening of older patients by nursing staff (OR 1.8, p-value <0.01), as well as on other aspects of delirium care. The number of patients diagnosed with delirium was reduced from 11.2% in the control phase to 8.7% in the intervention phase (p = 0.04). The e-learning course also showed a significant positive effect on nurses’ knowledge of delirium.
Nurses who undertook a delirium e-learning course showed a greater adherence to the quality improvement project in delirium care. This improved the recognition of patients at risk and demonstrated that e-learning can be a valuable instrument for hospitals when implementing improvements in delirium care.
The Netherlands National Trial Register (NTR). Trial number: NTR2885.
Anderson D: Preventing delirium in older people. Br Med Bull. 2005, 74 (1): 25-34. CrossRef
Kuehn BM: Delirium often not recognized or treated despite serious long-term consequences. JAMA. 2012, 304 (4): 389-395. CrossRef
Frail Elderly. [ http://www.vmszorg.nl/_page/vms_inline?nodeid=4571&subjectid=6702&configid=6484] In Dutch
Grol R: Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001, 39 (8): II46-II54. PubMed
IGZ (Dutch Healthcare Inspectorate): The results count hospitals. 2010, Utrecht; 2012. In Dutch
Wong G, Greenhalgh T, Pawson R: Internet-based medical education: a realist review of what works, for whom and in what circumstances. Med Educ. 2010, 10: 12-
Bloomfield JG, While AE, Roberts JD: Using computer assisted learning for clinical skills education in nursing: integrative review. JAN. 2008, 63 (3): 222-235. 10.1111/j.1365-2648.2008.04653.x. CrossRef
Van de Steeg L, Langelaan M, Ijkema R, Wagner C: The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial. Impl Sci. 2012, 7: 13-10.1186/1748-5908-7-13. CrossRef
Course offerings; Course delirium. [ http://www.noordhoff-health.nl/wps/portal/zorg/e-learning-ziekenhuizen-verpleegkundige/cursusaanbod] In Dutch.
Van der Mast RC, Huyse FJ, Droogleever Fortuijn HA, Heeren TJ, Izaks GJ, Kalisvaart CJ, Klijn FAM, Leentjens AFG, Sno HN, Schuurmans MJ, Wilterdink J, Hovestadt A, Kroeze MM, Rosier PFWM: Guideline delirium. 2004, Amsterdam: Nederlandse vereniging voor psychiatrie, In Dutch
Van Gemert LA, Schuurmans MJ: The Neecham Confusion Scale and the Delirium Observation Screening Scale: capacity to discriminate and ease of use in clinical practice. BMC Nurs. 2007, 6: 3-10.1186/1472-6955-6-3. CrossRef
Steverink N, Slaets JPJ, Schuurmans H, van Lis M: Measuring frailty: Developing and testing the GFI (Groningen Frailty Indicator). Gerontologist. 2001, 41 (1): 236-237.
de Blok C, Koster E, Schilp J, Wagner C: Implementation national patient safety programme. Evaluation study in Dutch hospitals. 2013, EMGO+/NIVEL: Amsterdam/Utrecht, In Dutch
- Can an e-learning course improve nursing care for older people at risk of delirium: a stepped wedge cluster randomised trial
Lotte van de Steeg
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II