OPTAmising prevention of delirium and other risks for older people in the ED through use of an assistant workforce: a pre- post study.

• Register: ANZCTR
• Last refreshed on: 29 May 2017
• Main ID: ACTRN12617000742370
• Date of registration: 22/05/2017
• Prospective Registration: No
• Primary sponsor: John Hunter Hospital
• Public title: OPTAmising prevention of delirium and other risks for older people in the ED through use of an assistant workforce: a pre- post study.
• Scientific title: OPTAmising prevention of delirium and other risks for older people in the ED through use of an assistant workforce: a pre- post study.
• Date of first enrolment: 1/07/2011
• Target sample size: 3000
• Recruitment status: Completed
• URL: http://www.anzctr.org.au/ACTRN12617000742370.aspx
• Study type: Interventional
• Study design: Non-randomised trial Single group
• Phase: Not Applicable

Health Condition(s) or Problem(s) studied

Delirium

Intervention(s)

The intervention was four full time equivalent (FTE) Older Person Technical Assistants (OPTAs) will be rostered between 8 am to 8pm in the ED, seven days a week for 12 months in 8 hour shifts. The OPTAs focus on screening and the supportive care of people over the age of 75 years who were not experiencing life threatening situations.

The prerequisites for selection as an OPTA include previous training or experience as a health care assistant or equivalent. On commencement in the ED, over a 5 day period ,the OPTAs will be oriented to the ED and hospital environment, trained and assessed in competency as assistants in nursing, patient privacy and dignity as well as the screening tools. They will be instructed on recording screening findings and supportive care in the electronic patient management system.

Screening undertaken includes:
*Six item screener, a brief cognitive assessment screen designed for EDs
*Confusion Assessment Method Instrument (CAMI) for delirium
*Falls Risk for Hospitalised Older People, a falls screening tool
*Identification of Seniors at Risk, a tool to identify patients at risk for ED representation
*Numerical rating scale for pain
*Waterlow screening tool for pressure injury risk screening
*Mini-Nutritional Assessment for nutrition and
*Modified Care Strain Index to screen for caregiver strain with long-term family caregivers.

In line with Australian clinical practice guidelines for the management of people with delirium, preventative environmental and clinical practice strategies are incorporated into the role. This multicomponent delirium prevention strategy consists of orienting the person to the ED environment, attending to nutrition, hydration and elimination needs, providing sensory and mobility aids, supervising and assisting moving, support when agitated and facilitating carer presence as often as possible. A delirium prevention box is available for OPTAs to use with patients this included daily newspapers, playing cards, games and puzzles, crosswords, a radio with ear phones and a clock. OPTAs also provided support to carers in the ED who are often older people themselves.

The setting is a tertiary referral hospital Emergency Department in New South Wales, Australia. In the year prior to this study, the ED had 67,000 ED presentations, 13 % of which were by patients over 75 years of age.