Documentation of delirium in the VA electronic health record

Lee

Pharmacoepidemiology and Drug

et al. 2017

115

Purpose To evaluate the performance of delirium-identification algorithms in administrative claims and drug utilization data. Methods We used data from a prospective study of 184 older adults who underwent aortic valve replacement at a single academic medical center to evaluate the following delirium-identification algorithms: 1) International Classification of Diseases (ICD) diagnosis codes for delirium, 2) antipsychotics use, 3) either ICD diagnosis codes or antipsychotics use, and 4) both ICD diagnosis codes and antipsychotics use. These algorithms were evaluated against a validated bedside assessment, the Confusion Assessment Method, and a validated delirium severity scale, the CAM-S. Results Delirium occurred in 66 patients (36%), of which 14 (21%) had hyperactive or mixed features and 15 (23%) had severe delirium. ICD diagnosis codes for delirium were present in 15 patients (8%). Antipsychotics were used in 13 patients (7%). ICD diagnosis codes alone and antipsychotics use alone had comparable sensitivity (18% vs. 18%) and specificity (98% vs. 99%). Defining delirium using either ICD diagnosis codes or antipsychotics use, sensitivity improved to 30% with little change in specificity (97%). This algorithm showed higher sensitivity for hyperactive or mixed delirium (64%) and severe delirium (73%). Requiring both ICD diagnosis codes and antipsychotics use resulted in perfect specificity, but low sensitivity (6%). Conclusion Delirium-identification algorithms in claims data have low sensitivity and high specificity. Defining delirium using ICD diagnosis codes or antipsychotics use performs better than considering either type of information alone. This information should inform the design and interpretation of claims-based comparative effectiveness and safety research.

Section: Introductionmentioning

confidence: 99%

Evaluation of algorithms to identify delirium in administrative claims and drug utilization database

Lee

Pharmacoepidemiology and Drug

et al. 2017

115

“…Patients with undetected delirium (i.e., no medical documentation but screened positive on a delirium measure) may thus be undertreated and are therefore at risk for several negative outcomes, including increased risk of mortality [4]. Several factors may contribute to under-detection of delirium in hospital settings, including problems with adequate documentation and communication between medical staff [5–6], heterogeneous terminology (e.g., confusion, mental status change, altered mental status), and differences in staff knowledge of delirium [7]. …”

Section: Introductionmentioning

confidence: 99%

“…In a retrospective chart-review of a psychiatric consultation service [9], approximately 63% of patients with delirium were misdiagnosed; these patients were younger and had a history of bipolar or psychotic disorder. In general hospital settings, those with undetected delirium had a relatively higher number of certain medical and neurological disorders compared to detected cases [6]. Among elderly patients admitted to one emergency department [10], 65% of delirium cases went undetected; those patients tended to have a greater frequency of pulmonary disease and less neurologic disease than detected cases.…”

Section: Introductionmentioning

confidence: 99%

Delirium Detection and Impact of Comorbid Health Conditions in a Post-Acute Rehabilitation Hospital Setting

et al. 2016

Misdiagnosis and under-detection of delirium may occur in many medical settings. This is important to address as delirium clearly increases risk of morbidity and mortality in such settings. This study assessed whether Veterans who screened positive on a delirium severity measure (Memorial Delirium Assessment Scale; MDAS) differed from those with and without corresponding medical documentation of delirium in terms of cognitive functioning, psychiatric/medical history, and medication use. A medical record review of 266 inpatients at a VA post-acute rehabilitation unit found that 10.9% were identified as delirious according to the MDAS and/or medical records. Of the Veterans who screened positive on the MDAS (N = 19), 68.4% went undetected by medical screening. Undetected cases had a higher number of comorbid medical conditions as measured by the Age-Adjusted Charlson Index (AACI) scores (median = 9, SD = 3.15; U = 5.5, p = .003) than medically documented cases. For Veterans with a score of 7 or greater on the AACI, the general relative risk for delirium was 4.46. Delirium is frequently under-detected in a post-acute rehabilitation unit, particularly for Veterans with high comorbid illness. The relative risk of delirium is up to 4.46 for those with high medical burden, suggesting the need for more comprehensive delirium screening in these patients.

Rev. Bras. Farm. Hosp. Serv. Saúde

“…Uma revisão de prontuários em um hospital americano mostrou que a frequência de casos de delirium identificados pela equipe de saúde mental e era muito superior do que os registrados em prontuários (22) . Estes estudos mostram como a falta de informações no prontuário do paciente pode prejudicar a assistência e subestimar dados importantes para traçar estratégias de segurança dentro de uma instituição de saúde.…”

Section: Discussionunclassified

Farmácia Clínica Em Ambiente Hospitalar: Enfoque No Registro Das Atividades

Lima¹,

Silva²,

Ricieri³

et al. 2017

Introdução: A análise da terapia farmacológica, a atuação interprofissional e o uso de ferramentas de pesquisa são contribuições do farmacêutico no suporte ao paciente e à equipe assistencial. Documentar as atividades profissionais relacionadas à assistência é fundamental para a continuidade do cuidado. Objetivo: Verificar a percepção e a prática do farmacêutico sobre o registro das atividades clínicas. Métodos: Estudo transversal com farmacêuticos de um hospital de Porto Alegre a partir da aplicação de um questionário em formato eletrônico com questões relacionadas ao perfil do farmacêutico (sexo, idade, formação), atuação em farmácia clinica (experiência) e registro de informações no prontuário (conhecimento, prática e importância), entre setembro e outubro de 2016. Foi realizada análise descritiva dos dados quantitativos, os dados qualitativos foram analisados por categorização de ideias centrais e frequência de acordo com o discurso do sujeito coletivo. Resultados: Dentre os 27 profissionais que compunham a amostra, foi possível contatar 26.73% dos farmacêuticos convidados participaram do estudo. Observou-se um perfil de farmacêuticos jovens (24 a 35 anos), em sua maior parte do sexo feminino (94,74%), com formação recente (01 mês a 12 anos) e em instituição privada (83,16%). Grande parte destes farmacêuticos (57,89% dos farmacêuticos) atua em mais de um setor (farmácias internas, satélites e central). Conclusões: Os farmacêuticos desta instituição reconhecem a importância e a necessidade de registrar suas atividades clínicas, no entanto, este registro não ocorre devido à inexperiência prática, sobrecarga de atividades, necessidade de elaboração de políticas institucionais e capacitação desses profissionais.Descritores: Farmacêutico, Serviço de Farmácia Hospitalar, Prontuário do Paciente, Farmácia Clínica. ABSTRACTBackground: The analysis of the pharmacological therapy, the inter-professional performance and the use of research tools are contributions of the pharmacist in the support of patient and the care team. Documenting care-related professional activities is critical to the continuity of care process. Objective: To check the pharmacist's perception and practice regarding the documentation of clinical activities. Methods: Cross-sectional study with pharmacists of a hospital in Porto Alegre based on the application of a questionnaire in electronic format with questions related pharmacist's profile (gender, age, formation), acting in clinical pharmacy (practice) and recording information in the medical record (knowing, practice and importance), between September and October 2016. Descriptive analysis of quantitative data was performed. Qualitative data were analyzed by categorization of central idea and frequency according the discourse of the collective subject. Results: Out of the 27 professionals, who made up a sample, were possible contacts 26.73% of the invited pharmacists participated in the study. A profile of young pharmacists (24 to 35 years old), mostly female (94.74%), with recent college concl...