BACKGROUND Delirium is a frequent complication of hospital admission among older people. Multicomponent interventions which can reduce incident delirium by ≈one-third are recommended by the National Institute of Health and Care Excellence. Currently, a standardised delirium prevention system of care suitable for adoption in the UK National Health Service does not exist. The Prevention of Delirium (POD) system of care is a theory informed, multicomponent intervention and systematic implementation process which includes a role for hospital volunteers. We report POD implementation and delivery processes in NHS hospital wards, as part of a feasibility study. METHODS A comparative case study design and participatory, multi-method evaluation was performed with sequential six month preparatory and six month delivery stages. Six wards in five hospitals in Northern England were recruited. Methods included: facilitated workshops; observation of POD preparatory activities; qualitative interviews with staff; collection of ward organisational and patient profiles; and structured observation of staff workload. RESULTS POD implementation and delivery was fully accomplished in four wards. On these wards, implementation strategies informed by Normalization Process Theory operated synergistically and cumulatively. An interactive staff training programme on delirium and practices that might prevent it among those at risk, facilitated purposeful POD engagement. Observation of practice juxtaposed to action on delirium preventive interventions created tension for change, legitimating new ways of organising work around it. Establishing systems, processes and documentation to make POD workable in the ward setting, enhanced staff ownership. 'Negotiated experimentation' to involve staff in creating, appraising and modifying systems and practices, helped integrate the POD care system in ward routines. Activating these change mechanisms required a particular form of leadership: pro-active 'steer', and senior ward 'facilitator' to extend 'reach' to the staff group. Organisational discontinuity (i.e. ward re-location and re-modelling) disrupted and extended POD implementation; staff shortages adversely affected staff capacity to invest in POD. Findings resulted in the development of 'site readiness' criteria without which implementation of this complex intervention was unlikely to occur. CONCLUSIONS POD implementation and delivery is feasible in NHS wards, but a necessary context for success is 'site readiness.'

中文翻译：

---

实施和提供预防of妄症护理系统的过程：一项混合方法初步研究。

背景技术Deli妄是老年人中住院的常见并发症。美国国立卫生与医疗保健研究院建议采取多成分干预措施，将incident妄事件减少约三分之一。目前，尚不存在适用于英国国家卫生服务局的标准化care妄预防护理系统。Deli妄预防（POD）护理系统是一种理论根据，具有多方面的干预作用，并且是系统的实施过程，其中包括对医院志愿者的作用。作为可行性研究的一部分，我们报告了NHS医院病房中POD的实施和交付过程。方法采用比较案例研究设计和参与式，多方法评估，依次进行六个月的准备和六个月的分娩阶段。招募了英格兰北部五家医院的六个病房。方法包括：举办讲习班；观察POD的准备活动；对工作人员的定性采访；病房组织和患者资料的收集；并有条理地观察工作人员的工作量。结果POD的实施和交付在四个病房中完全完成。在这些方面，以标准化过程理论为基础的实施策略可以协同，累积地运行。一项有关and妄和行为的互动式员工培训计划可能会在有风险的人中防止prevent妄，促进有目的的POD参与。观察到与del妄预防性干预措施并存的实践，为变革带来了压力，为围绕它的组织工作的新方式提供了合法性。建立系统，流程和文档，使POD在病房中可行，增强了员工的主人翁意识。通过使员工参与创建，评估和修改系统与实践的“谈判实验”，帮助将POD护理系统整合到病房常规中。激活这些变革机制需要一种特殊的领导方式：积极主动的“领导”和高级病房“促进者”，以将“覆盖范围”扩展到员工群体。组织的不连续性（即病房的重新定位和重新建模）破坏了POD的实施并扩大了其实施范围；员工短缺严重影响了员工在POD方面的投资能力。调查结果导致制定了“现场准备就绪”标准，没有这种标准，就不可能实施这种复杂的干预措施。