Exploration into the factors influencing evidence uptake of delirium management in intensive care. A qualitative descriptive study

Introduction: Delirium remains a commonly under recognised or misdiagnosed patient complication of admission to the ICU. Objectives: To explore clinicians’ perceptions of factors that affect the delivery of evidence-based practice for the assessment and management of delirium in adult ICU patients.Methods: This study, conducted in the 27-bed ICU of a major metropolitan quaternary public hospital in Queensland, Australia, used a qualitative descriptive design with purposive sampling and semi-structured in-depth one on one interviews. Clinicians, both medical professionals and registered nurses, employed in the study setting with greater than 12-months ICU experience were recruited. Interviews were audio recorded and transcribed verbatim. Transcripts were cross-checked by participants for veracity. Data were analysed using Braun and Clark’s six phases for thematic analysis. Results: Fifteen clinicians participated; 10 registered nurses and 5 medical staff specialists. Thematic analysis revealed the main barriers affecting delirium best-practice were: 1) the physical environment, including iatrogenic high noise levels and lighting, 2) cocktail of treatments, with continuance of frequent observations, reliance on multiple pharmacological agents and use of restraints, and 3) accessing evidence-based practice, including a lack of awareness of current guidelines and.using previous experience to guide practice. 4) A reactionary approach to treat rather than prevent. Enablers of best-practice approaches were shown in the themes of 1) family engagement, connecting with the family, 2) leadership, including support by peers and peer leaders, 3) exemplary practice, highlighted by going the extra mile and patient focussed care. Conclusions: This study highlights the existence of facilitators and barriers to the adoption of evidence -based practice approaches. Further research is required to develop site-specific evidence adoption strategies to address the iatrogenic complication of delirium.