ObjectiveTo identify existing prognostic delirium prediction models and evaluate their validity and statistical methodology in the older adult (≥60 years) acute hospital population.DesignSystematic review.Data sources and methodsPubMed, CINAHL, PsychINFO, SocINFO, Cochrane, Web of Science and Embase were searched from 1 January 1990 to 31 December 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and CHARMS Statement guided protocol development. Inclusion criteria: age >60 years, inpatient, developed/validated a prognostic delirium prediction model. Exclusion criteria: alcohol-related delirium, sample size ≤50. The primary performance measures were calibration and discrimination statistics. Two authors independently conducted search and extracted data. The synthesis of data was done by the first author. Disagreement was resolved by the mentoring author.ResultsThe initial search resulted in 7,502 studies. Following full-text review of 192 studies, 33 were excluded based on age criteria (<60 years) and 27 met the defined criteria. Twenty-three delirium prediction models were identified, 14 were externally validated and 3 were internally validated. The following populations were represented: 11 medical, 3 medical/surgical and 13 surgical. The assessment of delirium was often non-systematic, resulting in varied incidence. Fourteen models were externally validated with an area under the receiver operating curve range from 0.52 to 0.94. Limitations in design, data collection methods and model metric reporting statistics were identified.ConclusionsDelirium prediction models for older adults show variable and typically inadequate predictive capabilities. Our review highlights the need for development of robust models to predict delirium in older inpatients. We provide recommendations for the development of such models.

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Urinary tract infections are one of the most common hospital-acquired infections, with 70%-80% resulting from catheter-associated urinary tract infections (CAUTIs). We undertook a qualitative study to assess patient perspectives of indwelling urinary catheters using a semistructured interview. We found that patient awareness and patient engagement regarding indwelling urinary catheters and their consequences could be improved in the hospital setting. Implementing educational programs incorporating patient preferences for both health care workers and patients is likely to increase the involvement of patients in decision-making regarding urinary catheters and may lead to a decline in CAUTIs.

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Clinical nurse specialists were successful in collaborating with interdisciplinary colleagues to support the development of a Constant Observation Program that included video monitoring. In addition, clinical nurse specialists developed documentation, policies, and procedures to support this new technology. Success was evidenced by support of and growth of the program over time.