A study of the acceptability of a community delirium toolkit to healthcare staff

Background Delirium is a common reason for conveyance to hospital and subsequent hospital admission. However, there is increasing evidence, to show that delirium can be safely assessed and managed in the community. A community delirium toolkit has previously been developed and piloted in 4 of 10 localities constituting the area of Greater Manchester in Northwest England. Objectives We sought to evaluate the acceptability of the community delirium toolkit to healthcare teams involved in implementation in Greater Manchester (GM). Staff from teams with a high level of adoption were selected. Methods Eight qualitative structured one-to-one on-line interviews were completed with staff from three teams. Thematic coding was used following a framework analysis. Results Four themes emerged around implementation, benefits, challenges/suggested improvements and wider dissemination/sustained use of the community delirium toolkit. Organisational context was key to successful implementation. Staff perceptions of usefulness were an important motivator for staff. A key area of controversy prior to toolkit adoption, and perhaps a significant difference between hospital and home care in terms of accessibility, was the usefulness of blood tests. In this study we showed there was new appreciation around the usefulness of blood tests in investigating causes of suspected delirium in some cases. Key enablers were development of a co-produced toolkit and project management support with sharing of resources. Conclusions This study confirms that the GM community delirium toolkit was easy for the teams who engaged with the pilot to use and adopt it. In the UK and other countries there is a move towards provision of healthcare delivery in the community. This study has identified drivers and enablers for successful implementation of a clinical pathway to care for people with delirium safely in the home environment.