A quality improvement program to increase nurses' detection of delirium on an acute medical unit

Solberg, Laurence M.; Plummer, Carrie; May, Kanah N.; Mion, Lorraine C.

doi:10.1016/j.gerinurse.2012.12.009

Cited by 19 publications

(14 citation statements)

References 44 publications

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“…Published by Sciedu Press such as a quality improvement project by Solberg, Plummer, May, and Mion, [52] presented similar results as those found in this study. Solberg and colleagues [52] evaluated a quality improvement program where nurses were educated to use a structured bedside assessment tool for delirium in practice.…”

Section: Discussionsupporting

confidence: 89%

“…Solberg and colleagues [52] evaluated a quality improvement program where nurses were educated to use a structured bedside assessment tool for delirium in practice. The authors found that the quality improvement program resulted in nurses' implementation and adoption of a bedside delirium tool, [52] which assisted them with early recognition and treatment.…”

Section: Discussionmentioning

confidence: 99%

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Developing capacity to care for clients at risk for delirium and for acutely delirious clients

Ingram

Babenko-Mould

Booth

2015

JNEP

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The purpose of this mixed-methods study was to assess nurses' (N = 56) knowledge and self-efficacy of: a) caring for clients experiencing delirium, and b) caring for clients at risk of developing delirium in a hospital setting. Nurses completed study instruments prior to and immediately after taking part in a clinical education session. Seven nurses participated in a follow-up interview to explore their experiences of applying knowledge from the education session to the practice setting. Objectives of the education session included reviewing risks, signs, symptoms, standardized screening tools, and management strategies for clients at risk for or experiencing delirium in a hospital setting. Nurses were found to have improved knowledge and self-efficacy, as to the recognition and management of delirium. The qualitative findings highlighted nurses' rich experiences and revealed themes, namely, enhancing emotional intelligence, strengthening clinical judgment to enhance quality of care, and increasing competency for family care. This study demonstrates how continuing education in clinical practice can positively impact nursing knowledge, confidence, and application of knowledge into practice in efforts to decrease the prevalence of delirium. As such, an investment in continuing professional development education for delirium recognition and management is proposed to be a strategy that can positively impact client care.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Developing capacity to care for clients at risk for delirium and for acutely delirious clients

Ingram

Babenko-Mould

Booth

2015

JNEP

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“… 22 23 34 We note that other quality improvement projects in similar settings have not reported an increase in screening of delirium 35 or report difficulties in accuracy of assessment by ward nursing staff. 34 Factors that may have improved screening in this project may include (1) the use of 4AT as opposed to other screening tools and (2) the emphasis on the admitting junior doctor having the responsibility of recognition, rather than ward medical/nursing staff.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

TIME to think about delirium: improving detection and management on the acute medical unit

et al. 2018

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Delirium affects 18%–35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients and their families. We used quality improvement tools and a multicomponent intervention to promote detection and improve management of delirium on the acute medical unit (AMU). We reviewed whether a delirium screening tool (4AT) had been completed for all patients aged over 65 years admitted to the AMU over 1 week. If delirium was detected, we assessed whether investigation and management was adequate as per national guidance. After baseline data collection, we delivered focused sessions of delirium education for doctors and nursing staff, including training on use of the 4AT tool and the TIME (Triggers, Investigate, Manage, Engage) management bundle. We introduced TIME checklists, an online delirium order set and created a bedside orientation tool. We collected data following the interventions and identified areas for further improvement. Following our first PDSA (Plan, Do, Study, Act) cycle, use of the 4AT screening tool improved from 40% to 61%. Adequate assessment for the causes of and exacerbating factors for delirium increased from 73% to 94% of cases. Use of personal orientation tools improved from 0% to 38%. In summary, a targeted staff education programme and practical aids for the ward have improved the screening and management of delirium on the AMU. This may be improved further through more frequent training sessions to account for regular change-over of junior doctors and through implementing a nursing champion for delirium.

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“…Ongoing electronic audits demonstrate average CAM completion rates of 80%, compared with 64% on a similar medical unit. In addition and consistent with delirium screening literature (Rice, Bennett, Clesi, & Linville ; Solberg, Plummer, May, & Mion ), the accuracy of CAM assessments is an ongoing issue. Anecdotally, nurses sought more assistance to improve CAM accuracy and benefited from ongoing education and one‐on‐one coaching.…”

Section: Discussionmentioning

confidence: 76%

Use of a Multimodal Implementation Strategy to Improve Delirium Screening by Nurses on an Acute Care for Elders Unit

Afriyie-Boateng

Loftus

Hamelin

2015

Worldviews Ev Based Nurs

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A quality improvement program to increase nurses' detection of delirium on an acute medical unit

Cited by 19 publications

References 44 publications

Developing capacity to care for clients at risk for delirium and for acutely delirious clients

Developing capacity to care for clients at risk for delirium and for acutely delirious clients

TIME to think about delirium: improving detection and management on the acute medical unit

Use of a Multimodal Implementation Strategy to Improve Delirium Screening by Nurses on an Acute Care for Elders Unit

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