International Journal of Clinical Pharmacy

, Volume 39, Issue 6, pp 1194–1200 | Cite as

Current practice and opinions of hospital pharmacists regarding their role in the screening, prevention and treatment of delirium

  • Gizat M. Kassie
  • Lisa M. Kalisch Ellett
  • Tuan A. Nguyen
  • Elizabeth E. Roughead
Research Article

Abstract

Background An interdisciplinary approach is fundamental for effective prevention and treatment of delirium. Pharmacists could play a role in identifying and resolving medication-related delirium. However, little is known about their role in delirium care. Objective The main purpose of this survey was to assess the current practice and opinions of pharmacists concerning their involvement in screening, prevention and treatment of delirium. Setting Pharmacists in public and private hospitals in Australia. Method A cross-sectional survey was conducted using a pilot tested web-based questionnaire which was distributed primarily via a link in the electronic newsletter of the Society of Hospital Pharmacists of Australia. Main outcome measure Number and proportion of respondents answering questions related to the practice and perceptions of pharmacists in delirium management. Results Responses from 106 pharmacists were included in the analysis. Most respondents believed that pharmacists could play a role in prevention (92%) and screening (62%) of patients for delirium. However, in practice only 8% of pharmacists reported that they had ever screened a patient for delirium using a validated tool and 79% indicated that pharmacists were never or rarely involved in delirium treatment. When pharmacists did make recommendations half of the respondents said that pharmacists’ recommendations were frequently or always accepted by the delirium treating teams. Conclusion Hospital pharmacists are underutilised in the prevention and management of delirium. Strategies to increase their involvement in the prevention and management of delirium should be implemented.

Keywords

Australia Delirium Elderly Older people Pharmacists’ perception Practice model Survey 

Notes

Acknowledgements

We thank the Society of Hospital Pharmacists of Australia, Australasian Delirium Association, New South Wales Therapeutic Advisory Group and individuals who helped us in distributing the survey. Our gratitude also goes to reviewers of the questionnaire and pharmacists who participated in piloting the survey.

Funding

GMK is supported by an Australian Government Research Training Program Scholarship. LMKE and TAN are both supported by NHMRC-ARC Dementia Research Development Fellowships (LMKE Grant identification number APP1101788, TAN Grant identification number APP1103860). EER is supported by an NHMRC Senior Principal Research Fellowship (Grant identification number APP1110139). The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of NHMRC.

Conflicts of interest

Authors of this study confirm that there are no conflicts of interest related to this paper.

Supplementary material

11096_2017_547_MOESM1_ESM.docx (171 kb)
Supplementary material 1 (DOCX 171 kb)

References

  1. 1.
    Koster S, Hensens AG, Schuurmans MJ, van der Palen J. Consequences of delirium after cardiac operations. Ann Thorac Surg. 2012;93(3):705–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Rivosecchi RM, Smithburger PL, Svec S, Campbell S, Kane-Gill SL. Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse. 2015;35(1):39–51.CrossRefPubMedGoogle Scholar
  3. 3.
    Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc. 2011;59:S241–3.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Peisah C, Chan DKY, McKay R, Kurrle SE, Reutens SG. Practical guidelines for the acute emergency sedation of the severely agitated older patient. Intern Med J. 2011;41(9):651–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Eeles EM, Hubbard RE, White SV, O’Mahony MS, Savva GM, Bayer AJ. Hospital use, institutionalisation and mortality associated with delirium. Age Ageing. 2010;39(4):470–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Cull EJ, Kent B, Philips NM, Mistarz R. Risk factors for incident delirium in acute medical in-patients. A systematic review. JBI Datab Syst Rev Implement Rep. 2013;11(5):62–111.CrossRefGoogle Scholar
  7. 7.
    Kakuma R, Fort D, Galbaud G, Arsenault L, Perrault A, Platt RW, et al. Delirium in older emergency department patients discharged home: effect on survival. J Am Geriatr Soc. 2003;51(4):443–50.CrossRefPubMedGoogle Scholar
  8. 8.
    American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American geriatrics society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc. 2015;63(1):142–50.CrossRefGoogle Scholar
  9. 9.
    Hshieh Tammy T, Yue Jirong, Esther Oh, Puelle Margaret, Dowal Sarah, Travison Thomas, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med. 2015;175(4):512–20.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sockalingam S, Tan A, Hawa R, Pollex H, Abbey S, Hodges BD. Interprofessional education for delirium care: a systematic review. J Interprof Care. 2014;28(4):345–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Teslyar P, Stock VM, Wilk CM, Camsari U, Ehrenreich MJ, Himelhoch S. Prophylaxis with antipsychotic medication reduces the risk of post-operative delirium in elderly patients: a meta-analysis. Psychosomatics. 2013;54(2):124–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Gilmore ML, Wolfe DJ. Antipsychotic prophylaxis in surgical patients modestly decreases delirium incidence but not duration in high-incidence samples: a meta-analysis. Gen Hosp Psychiatry. 2013;35(4):370–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Fukata S, Kawabata Y, Fujisiro K, Katagawa Y, Kuroiwa K, Akiyama H, et al. Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial. Surg Today. 2014;44(12):2305–13.CrossRefPubMedGoogle Scholar
  14. 14.
    Neufeld KJ, Bienvenu OJ, Rosenberg PB, Mears SC, Lee HB, Kamdar BB, et al. The Johns Hopkins Delirium Consortium: a model for collaborating across disciplines and departments for delirium prevention and treatment. J Am Geriatr Soc. 2011;59(02):S244–8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Pellegrin KL, Krenk L, Oakes SJ, Ciarleglio A, Lynn J, McInnis T, et al. Reductions in medication-related hospitalizations in older adults with medication management by hospital and community pharmacists: a quasi-experimental study. J Am Geriatr Soc. 2017;65(1):212–9.CrossRefPubMedGoogle Scholar
  16. 16.
    O’Mahony D. Pharmacists and prevention of inappropriate prescribing in hospital. Age Ageing. 2016;45(2):181–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Kalabalik J, Brunetti L, El-Srougy R. Intensive care unit delirium a review of the literature. J Pharm Pract. 2014;27(2):195–207.CrossRefPubMedGoogle Scholar
  18. 18.
    Devlin JW, Bhat S, Roberts RJ, Skrobik Y. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states. Ann Pharmacother. 2011;45(10):1217–29.CrossRefPubMedGoogle Scholar
  19. 19.
    Ely EW, Stephens RK, Jackson JC, Thomason JW, Truman B, Gordon S, et al. Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med. 2004;32(1):106–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Gong ZP, Liu XW, Zhuang YY, Chen XP, Xie GH, Cheng BL, et al. Survey of attitudes and behaviors of healthcare professionals on delirium in ICU. Chin J Traumatol. 2009;12(6):328–33.PubMedGoogle Scholar
  21. 21.
    Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.CrossRefPubMedGoogle Scholar
  22. 22.
    Brummel NE, Vasilevskis EE, Han JH, Boehm L, Pun BT, Ely EW. Implementing delirium screening in the intensive care unit: secrets to success. Crit Care Med. 2013;41(9):2196.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Australian Commission on Safety and Quality in Health Care. A better way to care: Safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital—Actions for health service managers. Sydney: ACSQHC; 2014.Google Scholar
  24. 24.
    Sri-on J, Tirrell GP, Wuthisuthimethawee P, Liu SW. Knowledge and practices of Thai emergency physicians regarding the care of delirious elderly patients. Int J Emerg Med. 2014;7:38.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Gesin G, Russell BB, Lin AP, Norton HJ, Evans SL, Devlin JW. Impact of a delirium screening tool and multifaceted education on nurses’ knowledge of delirium and ability to evaluate it correctly. Am J Crit Care. 2012;21(1):e1–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health ResearchUniversity of South AustraliaAdelaideAustralia

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