Authors
  • Annmarie Hosie1,
  • Meera Agar2,
  • Linda Brown2,
  • Gideon Caplan3,
  • Gideon Caplan4,
  • Brian Draper3,
  • Brian Draper4,
  • Stephen Hedger5,
  • Debra Rowett6,
  • Penelope Tuffin7,
  • Seong L Cheah2,
  • Jane L Phillips2,
  • Manraaj Sidhu2,
  • David Currow2
Organisations
  • University of Notre Dame1,
  • University of Technology Sydney (UTS)2,
  • Prince of Wales Hospital3,
  • University of New South Wales (UNSW)4,
  • Flinders University5,
  • University of South Australia6,
  • Royal Perth Hospital7
Year

2020

Excerpt
Introduction

Recent high-level studies and the Delirium Clinical Care Standard signal the need to reverse the routine use of antipsychotics and other unregistered medications for delirium.

Objectives
  1. To investigate clinicians’ (doctor, nurse practitioner, registered nurse, pharmacist) self-reported practice and practice change since 2016 in delirium treatment in palliative care and other specialties, focused on antipsychotic use;
  2. Identify factors influencing delirium treatment practice according to the Theoretical Domains Framework (TDF).
Methods

Online survey with 22 items: nine demographic; a question about frequency of encountering new patients with delirium; ten on current practice; and ten on practice change and influencers. Current practice items included goals of antipsychotic use for delirium. Practice influencer items included prompts about key negative studies of antipsychotics for delirium. Open-ended items enabled unprompted responses about other influencers and practice change characteristics. Recruitment via 15 professional organisations was in April-July 2019. Practice influencers were categorised using the TDF. Descriptive statistics were used to summarise results.

Results

There were 475 valid responses from 342 registered nurses, 79 doctors, 29 nurse practitioners and 25 pharmacists, representing all Australian states and territories. Most common workplaces were hospitals and residential aged care; 61% respondents encountered new patients with delirium at least daily or weekly; and 30% worked in palliative care. Just over half (59%) reported practice change in delirium treatment in the preceding three years, most often increased non-pharmacological intervention (53%) and decreased medication use (35%). Compared to respondents from other specialties, a greater proportion of palliative care respondents were aware of the named negative studies (75% vs 38%), yet more reported using antipsychotics (79% vs 44%) and other unregistered medications to treat delirium in the preceding 12 months, and for higher proportions of delirious patients. Most common goals of antipsychotic use were to decrease patient distress and restrain behaviours. Common influencers on palliative care respondents’ practice were emotion, knowledge, beliefs about consequences, and social and environmental factors.

Conclusion

Theory- and evidence-based practice change initiatives are required to support palliative care and other clinicians to de-implement their frequent use of antipsychotics and other unregistered medications for delirious patients.