Modified Delphi Study on Best Practice Recommendations for Microtransitions
What is a Modified Delphi Study?
A modified Delphi study is a research method used to build consensus among experts on complex topics where clear evidence or guidelines may not yet exist. It involves several rounds of surveys in which experts on a topic anonymously share their opinions, review group feedback, and refine their responses.
Why Use a Delphi Approach for Microtransitions?
Since little research has evaluated interventions for microtransitions, a Delphi approach makes sense to help develop recommendations for practice. We conducted a modified Delphi study involving 39 interdisciplinary national experts. The goal was to identify best practice recommendations (BPRs) that balance safety, autonomy, and feasibility in real-world nursing home environments. 51 BPRs were developed and published, along with 5 microtransitions considerations.
Lessons From The Microtransitions Delphi Study
It is important to consider communication, adverse event preparation and mitigation, the transition's the purpose and destination, environmental and equipment needs, and the skill level of the escort when planning a microtransition. Below, you can find the most clinically beneficial and feasible best practice recommendations, as determined by the expert Delphi panel, grouped into these five categories. A full list of all 51 recommendations is available in the full-text article, at the bottom of the page.
Best Practice Recommendations for Microtransitions
Communication And Transfer of Information
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Include the patient/resident, nursing teams, clinical care teams, recreational staff, facility primary care team, trip escorts, and responsible parties in communication and decision-making
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Communicate dietary modifications and restrictions, next medication administration times, monitoring parameters, education on specialized equipment, transmission-based precautions, new recommendations, medications, diagnoses, treatments and orders
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Transfer information via verbal (ideal), portal, electronic medical record, email, or fax communication.
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Communicate essential information related to the status of cognitive impairment with trip escorts and new care teams.
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Ask residents if they want to participate.
Adverse Event Monitoring, Preparation, and Mitigation
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Ensure availability of prescribed, emergency medications for life threatening conditions.
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Implement a plan to safely administer all medications that are due during an outing.
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Outline a behavioral care plan before outings
Purpose and Destination of Transition
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Utilize an appropriate number of trip escort(s) based on the trip’s location, specific outing activities, and risk for wandering.
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Evaluate risk-benefit in the event of acute medical or cognitive changes based on the outing’s purpose.
Equipment and Environmental Safety Considerations
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Bring necessary glasses, hearing aids, mobility devices, or other medical supplies.
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Adjust apparel based on environment and climate.
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Place pictures, furniture, and other room items in familiar locations during room changes.
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Communicate transportation and accessibility needs to those assisting with outings.
Skill Level of Caregiver/Escort
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Bring necessary glasses, hearing aids, mobility devices, or other medical supplies.
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Adjust apparel based on environment and climate.
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Place pictures, furniture, and other room items in familiar locations during room changes.
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Communicate transportation and accessibility needs to those assisting with outings.