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Table 2 CogChamps: Expected project outcomes and evaluation methods

From: CogChamps – a model of implementing evidence-based care in hospitals: study protocol

Expected outcome Evaluation Method Tool/Details
Increased Nurses’ knowledge of dementia and delirium Delirium knowledge questionnaire administered immediately prior to Workshop 1, and re-administered immediately prior to Workshop 2.
CogChamps will also be encouraged to administer this tool to other nurses on their wards prior to, and following any CI education they undertake, if CI education is included in their ward’s Action Plan.
The questionnaire includes 15 True/False items relating to delirium features and risk factors, and five validated vignettes, developed specifically for nurses [34]. Five vignettes will be included in the baseline questionnaire and another five (matched for diagnostic complexity) will be administered at follow-up.
True/False items - As a literature search failed to identify any well validated tools for assessing nurse’s delirium knowledge, the 15 items common to the Delirium Knowledge Questionnaire [35] and an assessment tool developed by Wand and colleagues [36] were selected.
Increased Nurses’ self-confidence when nursing patients with delirium or confusion Single item assessing nurses’ self-confidence administered immediately prior to Workshop 1 and re-administered immediately prior to Workshop 2. Single item statement answered using a 1–5 scale where 1 = not at all confident and 5 = very confident. The item was a slight adaptation of a previously used item [37].
Increased number of nurses at the IH who are proficient in assessing delirium. Direct observation of CAM administration and interpretation by an expert. Following Workshop 1. Proficiency will be established by observing CogChamps administer a CAM to a patient and interpret it.
Increased proportion of older patients who are routinely assessed for CI at admission to the hospital. Room & Chart Audit/Observation tool
These data will be collected on multiple occasions throughout the project –
(1) Pre- intervention,
(2) Following the CogChamps training,
(3) Following the implementation of ward specific Action Plans, and
(4) Three months following withdrawal of the research team.
The room & chart audit/observation tool included an item regarding cognitive assessment – ‘There is documentation that the patient’s cognitive function was assessed using a standardized assessment tool within 24 h of admission to the ward’. This item was adapted from a similar item developed by Schnitker and colleagues for use in the hospital Emergency Department [38].
Increased implementation of best practice guideline for delirium prevention, management and treatment. Audits of patient rooms and charts. These data will be collected on the same four occasions as the previous item.
Direct observations of Nurse: patient interactions.
The room & chart audit/observation tool
includes questions relating to cognitive assessment, pain assessment and management (e.g., Was a pain assessment undertaken? Had analgesia been administered within the last 24 h?), and antipsychotic/benzodiazepine use (Was the patient prescribed or administered any PRN antipsychotic/benzodiazepine medication within the past 24 h?).
Items requiring direct observation include aspects of the environment (e.g., Was there a clock set to the correct time, that the patient could see from his/her bed?); nutrition (Was adequate assistance provided to the patient if the patient had difficulty eating or drinking); restraint use (Was the patient restrained?); use of indwelling catheters (IDC; Did the patient have an IDC in situ?), communication (If the patient exhibited confusion/dis-orientation, did the nurse say anything to re-orient the patient?), and patient activity (What was the patient doing when you entered the room?).
Older patients with CI will have fewer adverse outcomes. Data regarding adverse outcomes from the hospital’s administrative database will be extracted at each data collection point and compared across data collection points and between the IH and CH. Data regarding falls and antipsychotic use will be obtained from the hospital’s database.