Abstract
The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July 2010 that included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy that has proven effective and cost-effective at preventing functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for seven of the NICE recommendations. Given interest by new HELP sites to meet NICE guidelines, three new protocols addressing hypoxia, infection, and pain that were not previously included in the HELP program were developed. In addition, the NICE dehydration guideline included constipation, which was not specifically addressed in the HELP protocols. This project describes the systematic development of three new protocols (hypoxia, infection, pain) and the expansion of an existing HELP protocol (constipation and dehydration) to achieve alignment between the HELP protocols and NICE guidelines. Following the Institute of Medicine recommendations for developing trustworthy guidelines, an interdisciplinary group of experts conducted a systematic review of current literature, rated the quality of the evidence, developed intervention protocols based on the highest-quality evidence, and submitted the protocols first to internal review and then to external review by an interdisciplinary panel of experts. The protocols were revised based on the review process and incorporated into the HELP materials. Inclusion of these protocols enhances the scope of the HELP program and allows fulfillment of NICE guideline recommendations for delirium prevention. The rigorous process applied may provide a useful example for updating existing guidelines or protocols that may be applicable to a broad range of clinical applications.
Highlights
The Hospital Elder Life Program (HELP, http://www.hospitalelderlifeprogram.org) was developed in 1993 as a targeted multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons.[1, 2] The HELP program is an innovative model of care designed to integrate with hospital nursing staff to ensure that older patients remain as independent as possible throughout hospitalization
The systematic approach undertaken in this project has allowed full operationalization of the National Institute for Health and Clinical Excellence (NICE) guidelines for delirium prevention in the HELP model of care
Incorporating state-of-the-art evidence from systematic review of the literature, we developed three new HELP protocols addressing hypoxia, infection control, and pain management
Summary
The Hospital Elder Life Program (HELP, http://www.hospitalelderlifeprogram.org) was developed in 1993 as a targeted multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons.[1, 2] The HELP program is an innovative model of care designed to integrate with hospital nursing staff to ensure that older patients remain as independent as possible throughout hospitalization. The overarching goals of HELP are to maintain physical and cognitive function throughout hospitalization; maximize independence at discharge; assist with the transition from hospital to home; and, prevent unplanned readmission. The program provides skilled interdisciplinary staff and trained volunteers to implement intervention protocols targeted toward six evidence-based delirium risk factors, which include orientation, therapeutic activities, early mobilization, vision and hearing optimization, oral volume repletion, and sleep enhancement. All patients are screened for eligibility, and interventions are assigned according to which risk factors are present. Adherence with interventions is tracked daily, and quality assurance measures are incorporated at each step of the program
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