| Description |
Background: Hospital-acquired delirium (HAD) is a fluctuating neurocognitive disorder that is marked by inattention, disorganized thinking, and altered levels of consciousness. It is particularly prevalent among hospitalized older adults, a concern becoming more critical in our growing elderly population (Ghezzi, 2022). HAD is associated with adverse outcomes that include prolonged hospital stays, increased rates of injuries and falls, higher healthcare costs, and elevated morbidity and mortality (Hirschman et al., 2020; Jain et al., 2011). Risk factors for this condition include advanced age, cognitive impairment, and underlying medical conditions. These factors are often compounded by the environment and the effects of medication, demonstrating the need for early detection and management in a hospital setting. Local Problem: An urban hospital in Utah identified the need for a consistent protocol for delirium screening in care areas outside of the intensive care units (ICUs). A clear process for evidence-based screening and management will improve timely diagnosis and intervention and improve patient safety. Methods: This project was conducted on an orthopedic trauma and surgery unit in an urban teaching hospital. This unit has 36 beds and cares for a diverse patient population, including those with traumatic injuries, complex fractures, and those who require elective orthopedic procedures. An evidence-based quality improvement (QI) project was conducted to identify and implement a standardized process for delirium screening. Interventions: After identifying the unit's lack of standardized education and screening protocols, the Confusion Assessment Method (CAM) non-ICU screening tool and a prevention protocol were implemented. Staff completed pre-implementation assessments with questions addressing their knowledge of delirium and available resources. The nurses then received education on the use of CAM and a delirium prevention order set through a PowerPoint presentation. Ongoing monitoring occurred through PDSA cycles, and real-time adjustments to workflow were made. Post-implementation assessments readdressed knowledge about HAD and addressed usability, feasibility, and satisfaction. Results: After this quality improvement project, the unit's nurses reported an overall percentage increase of 31% in their ability to recognize signs and symptoms associated with HAD. Overall, 93% (n=37) of the nurses agreed that the CAM non-ICU screening tool was easy to use and interpret. Knowledge among the nursing staff regarding the steps to take when delirium was suspected based on the CAM non-ICU screening tool rose to 93% (n=37), up from the initially reported 35% (n=7). The high screening rate demonstrates the project's overall feasibility, with 94% (n=164) of all eligible patients screened and 95% (n=18) that screened positive receiving the prevention protocol. Satisfaction with delirium care increased from 25% (n=1) to 95% (n=19), and 90% (n=36) of nurses reported their intent to continue using the CAM non-ICU tool. Conclusion: The CAM non-ICU screening tool and delirium prevention protocol were feasible, well-utilized, and associated with improved nurses' confidence, awareness, and satisfaction. These findings support the continued use of the tool as an effective intervention for HAD prevention and management. |
