Clinical checklists of multicomponent non-pharmacological interventions for delirium management in adult patients in non-ICU inpatient healthcare settings: a rapid review.

内容摘要

To identify clinical checklists of multicomponent non-pharmacological interventions for the prevention and treatment of delirium used in non-intensive care unit inpatient healthcare settings, their content and reported implementation. Rapid review. Medline, Embase, PsycINFO, CINAHL and Cochrane CENTRAL were searched from 1 January 1999 to 31 March 2022 and updated on 16 January 2025. A comprehensive grey literature search, including websites of guideline development groups and international delirium organisations, was conducted on 26 and 27 February 2024. We included records reporting the use of a 'clinical checklist' used by the healthcare team, family carers or adult patient (≥18 years) to prompt and document multicomponent non-pharmacological interventions for the prevention or treatment of delirium. Publication language was restricted to English and French. Using rapid review methodology, two independent reviewers screened the included records. A single reviewer undertook the data extraction, with a third independent reviewer verifying the data extraction for completeness. All included studies were assessed using the JBI critical appraisal tools according to the study design. A narrative synthesis was used to summarise the findings. From the database searches, 4796 records were identified. After the removal of duplicates, 3513 records underwent title and abstract screening, with 344 records undergoing full-text screening. A final 32 records were included. From the grey literature search, 6593 records were reviewed for relevance, from which 62 records were included in full-text screening. No grey literature records were of high enough quality to be included. All studies were published in English, with most studies conducted in the USA, n=12/32 (37.5%). The 32 studies were quasi-experimental (n=18), randomised controlled trials (n=8), qualitative (n=4), expert opinion (n=1) and policy/consensus guidelines (n=1). Clinical checklists included structured protocols, algorithms and order sets, which were paper-based or part of electronic delirium order sets. People with dementia participated as key stakeholders for a guidance document during the COVID-19 pandemic, but the target population was not included in the development phase of other checklists. Target users of clinical checklists were usually healthcare staff and trained volunteers and rarely family carers and study intervention nurses. Four of the 32 studies included all 10 National Institute for Health and Care Excellence clinical factors/preventive strategies for non-pharmacological interventions. For the remaining 28 studies, missing domains varied and included: therapeutic/cognitive activity, hydration, nutrition, constipation, urinary catheterisation, hypoxia, infection, pain and medication review. Only two studies involved family carers as active partners in patient care. Reported formal economic analysis was limited. Codesign of future clinical checklists should involve patients and family carers. Further research is needed on the feasibility of using clinical checklists by all members of the interprofessional team and family carers, the factors needed to ensure high levels of adherence and sustainability of multicomponent non-pharmacological interventions for delirium management, in addition to economic evaluations. CRD42022342328.