Choosing the Right Delirium Assessment Tool

Mulkey, Malissa; Roberson, Donna W.; Everhart, D. Erik; Hardin, Sonya R.

doi:10.1097/jnn.0000000000000403

Cited by 23 publications

(34 citation statements)

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“…The most frequently used tools are The Confusion Assessment Method (CAM) [40], CAM-ICU [41], The Delirium Rating Scale (DRS) [42] and the DRS revised version DRS-R98 [43]. The 4AT [44] utilised in this study, is most suited to the acute care population, takes 2 min to complete and does not require special training to learn [45]. The application of delirium assessment tools and the identification of delirium have been identified as facilitating the delivery of appropriate management [46] and therefore reducing associated morbidity [47].…”

Section: Introductionmentioning

confidence: 99%

A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults

et al. 2021

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Background Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium. Methods Two hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript. Results The audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant. Conclusion An interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool.

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Section: Introductionmentioning

confidence: 99%

A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults

et al. 2021

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“…Using a standardized assessment tool for sedation and agitation can assist with identifying patients who may be developing hypoactive and hyperactive delirium symptoms (Mulkey, Roberson, et al, 2018). Likewise, use of these assessment screening tools can differentiate delirium subtypes in patients identified.…”

Section: Identification and Assessmentmentioning

confidence: 99%

Considering Causes for Hypoactive Delirium

Mulkey

Hardin

Olson³

et al. 2019

Australasian Journal of Neuroscience

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Delirium is defined as a mental disorder characterized by an abnormal state of cognition and awareness. Delirium is associated with an annual cost of $350 billion between the United States and Europe. Approximately 80% of delirium cases are either not identified or misdiagnosed. Older adults have the highest incidence due to the consequences of aging. Hypoactive delirium or "quite delirium" is the most common delirium subtype experienced by older adults.Hypoactive delirium, is difficult to recognize and has worse outcomes than other subtypes. If detected, symptoms of hypoactive delirium are frequently dismissed as depression or dementia. Therefore, nurses need heightened vigilance in assessment and identification of hypoactive delirium. This article seeks to assist nurses in identifying hypoactive delirium by outlining factors that increase an individual's potential for developing hypoactive delirium.

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“…Patients who develop delirium are more likely to suffer from hospital-associated complications (p< 0.001), have higher in hospital (p=0.002) and 30-day mortality rates (p=0.008), to need repeat interventions, and longer length of hospital stay (p=0.007) increased need for acute rehabilitation, skilled nursing and long-term acute care after discharge compared to those who did not develop delirium (Radinovic et al, 2015;Tarazona-Santabalbina et al, 2015). Because of delays in identification, most older adults will still have delirium at the point of hospital discharge, posing an ongoing challenge regarding the need for facility-based post-acute care (Mulkey, Roberson, Everhart, & Hardin, 2018). When patients with prior cognitive impairment develop delirium there is an increase in mobility impairments, highlighting the importance of delirium preventions and cognitive therapies.…”

Section: Consequences Of Misdiagnosismentioning

confidence: 99%

Distinguishing Delirium from Dementia

Everhart

Mulkey

Hardin

et al. 2019

jhcs

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Distinguishing between delirium and dementia is essential for understanding the underlying mechanisms which direct a nurse to the best interventions. However, delirium and dementia are conditions that are at times difficult to differentiate even for experienced clinicians. While the similarities can make distinguishing between the two disorders challenging, there are distinct differences. Therefore, this article describes similarities and differences in the characteristics of each condition to assist clinicians in accurate detection and identification.

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Choosing the Right Delirium Assessment Tool

Cited by 23 publications

References 1 publication

A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults

A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults

Considering Causes for Hypoactive Delirium

Distinguishing Delirium from Dementia

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