Delirium - Education and Implementation Co-Design Approaches for READI-SET-GO Using CFIR Framework

Sep 29, 2026

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Delirium in hospitalized older adults can cause serious harms, including falls, antipsychotic use, misdiagnosis as Alzheimer’s disease, cognitive decline, and mortality. Early detection is essential but hindered by competing priorities, limited time, discomfort with screening tools, and insufficient leadership support. This study evaluates education and implementation co-design to integrate Ultra-Brief Confusion Assessment Method (UB-CAM) screening into the EHR and improve delirium screening and management. A stepped-wedge design across three hospitals over 42 months examines adoption using RE-AIM and CFIR-guided strategies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background

Early detection barriers

Method

Stepped-wedge design and UB-CAM screening

Implementation strategies

RE-AIM and CFIR-guided education and organizational actions

Results

Nurse education completion and hybrid training

Discussion and future research

EHR integration and sustainability

680 Innovation in Aging, 2025, Vol. 9, No. S2 SESSION 7060 (POSTER) DELIRIUM Abstract citation ID: igaf122.2319 EDUCATION AND IMPLEMENTATION CO-DESIGN APPROACHES FOR READI-SET-GO USING CFIR FRAMEWORK Zahra Karimi1, Priyanka Shrestha2, Jessica Fleming1, Erica Husser1, Donna Fick1, Edward Marcantonio4, and Chia Jou Lin5, 1. The Pennsylvania State University, University Park, Pennsylvania, United States, 2. The George Washington University, Washington, District of Columbia, United States, 4. Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States, 5. Taipei Medical University, Taipei City, Taipei, Taiwan (Republic of China) Background: Delirium in hospitalized older adults can lead to severe outcomes, including falls, antipsychotic use, and misdiagnosis as Alzheimer’s disease, contributing to cognitive decline and mortality. Early detection is critical, yet implementation barriers include lack of clinical prioritization, competing demands, time constraints, discomfort with screening tools, and limited leadership support. This study explores education and implementation strategies for integrating the Ultra-Brief Confusion Assessment Method (UB-CAM) into the electronic health record (EHR) to enhance delirium screening and management. Method: Using a stepped-wedge design across three hospitals over 42 months, nurses conduct daily UB-CAM screenings, with new units launching every six months. Implementation strategies are guided by RE-AIM and CFIR frameworks and include: (1) EHR-integrated app-based screening, (2) stakeholder engagement, (3) co-designed education (in-person and online),(4) hands-on case-based practice with feedback, and (5) addressing organizational factors such as leadership, culture, and workflow alignment. Results: In the first intervention block, 100% of eligible nurses completed the education program (65% in-person, 35% online), utilizing video-based case studies for hands-on learning and feedback. We describe champion selection, use of screening feedback reports, leadership engagement, and co-design of clinical strategies to enhance adherence. Discussion: UB-CAM integration into EHR, combined with co-designed education and multifaceted implementation strategies, has improved engagement and adherence. Hybrid training, technology-driven formats, and organizational leadership involvement have optimized adoption. Future research should assess the sustainability of these approaches for delirium screening.

FAQs

What problem does the study address in hospitalized older adults?

The study targets delirium, which can lead to falls, antipsychotic use, misdiagnosis as Alzheimer’s disease, cognitive decline, and mortality. It emphasizes the need for earlier detection despite practical barriers to screening.

How is UB-CAM implemented in this research?

Nurses conduct daily Ultra-Brief Confusion Assessment Method (UB-CAM) screenings using an EHR-integrated app-based approach. The stepped-wedge design rolls out new units every six months across three hospitals over 42 months.

Which implementation strategies guide the education and rollout?

Strategies are guided by RE-AIM and CFIR frameworks and include stakeholder engagement, co-designed education (in-person and online), hands-on case-based practice with feedback, and organizational actions such as leadership, culture, and workflow alignment.

What outcomes are reported for nurse education and adoption?

In the first intervention block, 100% of eligible nurses completed the education program, with 65% completing in-person and 35% completing online. The study reports improved engagement and adherence through co-designed strategies and hybrid training approaches.

Sep 29, 2026

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