PT - JOURNAL ARTICLE AU - Christina Reppas-Rindlisbacher AU - Shailee Siddhpuria AU - Eric Kai-Chung Wong AU - Justin Yusen Lee AU - Christopher Gabor AU - Alexandra Curkovic AU - Yasmin Khalili AU - Caroline Mavrak AU - Sandra De Freitas AU - Kristeen Eshak AU - Christopher Patterson TI - Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project AID - 10.1136/bmjoq-2020-001186 DP - 2021 Jan 01 TA - BMJ Open Quality PG - e001186 VI - 10 IP - 1 4099 - http://bmjopenquality.bmj.com/content/10/1/e001186.short 4100 - http://bmjopenquality.bmj.com/content/10/1/e001186.full SO - BMJ Open Qual2021 Jan 01; 10 AB - Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one of the most common postoperative complications in older adults undergoing orthopaedic surgery. Multicomponent, non-pharmacological interventions can reduce delirium incidence by up to 30% but are often challenging to implement as part of routine care. We identified a gap in the delivery of non-pharmacological interventions on an orthopaedic unit. This project aimed to implement a bedside sign on an orthopaedic unit to reduce the occurrence of delirium by prompting staff to use multicomponent evidence-based delirium prevention strategies for at-risk older adults. Quality improvement methods were used to integrate and optimise the use of a bedside ‘delirium prevention’ sign on an orthopaedic unit.The sign was implemented in four target rooms and sign completion rates increased from 47% to 83% (95% CI 71.7% to 94.9%; p<0.001) over a 10-month period. The sign did not have a significant impact on delirium prevalence. The mean Confusion Assessment Method (CAM)+ rate during the baseline period was 8% with an absolute increase in the intervention period to 11.4% (95% CI 7.2% to 15.8%; p=0.31). There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.