Assessment and management of delirium in a tertiary hospital-Improvements in cognitive screening and use of non-pharmacological strategies with a multidisciplinary approach.

OBJECTIVE: This series of audits aimed to determine current best practice in delirium management in a tertiary teaching hospital and to identify strategies to improve the quality of care in delirium with a focus on prevention. METHODS: We completed a series of audits following the formation of the Cognitive Impairment Reference Group, a multidisciplinary team that was created to implement delirium management guidelines and monitor compliance. Audit 1 focused on antipsychotic use in patients aged 66 years and older. Audit 2 reviewed delirium care in the Acute Medical Ward. Audit 3 included ethnographic data and investigated the use of non-pharmacological methods to prevent and manage delirium in the Geriatric Ward. Two years on, Audit 4 is a repeat of Audit 1. RESULTS: There were improved rates of cognitive screening between Audits 2 and 3 from 65% n = 40 to 86% n = 102, respectively. Most patients had one form of non-pharmacological strategy in place to prevent delirium however few had a multicomponent approach. Fewer patients were prescribed benzodiazepines alongside antipsychotics 28.57% n = 35 in Audit 1 compared to Audit 4 12.5% n = 32. CONCLUSIONS: Improved quality of care in delirium management is achievable via a co-ordinated multidisciplinary approach. These audits demonstrated improvements in both rates of cognitive screening, and use of non-pharmacological strategies prior to antipsychotic medication use and better adherence to guidelines for antipsychotic prescribing. Areas for further development in delirium prevention include the uptake of screening and individualised non-pharmacological strategies.

Medication information and supply behaviours in elite and developing athletes.

OBJECTIVES: To investigate the behaviours of elite and developing athletes in obtaining medications and medication information, and to identify the role of pharmacists in athlete care. DESIGN: Cross-sectional survey. METHODS: An electronic, 39-item questionnaire was developed, piloted and distributed to elite and developing athletes aged 18 years and above at a state-based sporting institute. Quantitative data was analysed using descriptive statistics and free text comments were analysed using an inductive reasoning approach. RESULTS: A total of 98 responses were analysed. Ninety (n=90/98, 91.84%) participants obtained medications in the six months prior to survey completion. Pharmacies were the most common source of both prescription (n=67/69, 97.10%) and non-prescription medications (n=64/75, 85.33%). Forty-five (n=45/98, 45.92%) participants also attended pharmacies when they had a minor ailment. Sixty-two (n=62/98, 63.27%) participants 'sometimes' consulted pharmacists for medication information. Only 11 (n=11/98, 11.22%) knew, according to their sporting institute medication policy, that athletes were required to consult a medical practitioner before taking anti-inflammatory, pain-relieving or sleep-inducing medications. Forty (n=40/98, 40.82%) participants believed pharmacists could play a role in their medication management. CONCLUSIONS: Many elite and developing athletes visited pharmacies for medication supply and treatment of minor ailments. Doping regulatory agency websites were the most commonly used and trusted sources for medication information, although some athletes believed pharmacists could also contribute to their medication management. Future research should consider whether pharmacists are ready for a role in sports pharmacy.