Nurse-Driven Assessment, Prevention, and Management of Delirium on an Acute Inpatient Neurology Unit

Abstract

Background: Delirium commonly affects hospitalized patients and is associated with increased hospital length of stay, discharge to skilled care, cost, morbidity, and mortality. Local Problem: At our organization, there was no formal delirium assessment performed by the nursing staff outside of the intensive care unit. Methods: Assessment of nurses' knowledge about delirium, a nurse-driven delirium screening protocol, and patient education were implemented on an adult inpatient neurology unit. Knowledge change, protocol implementation, and patient-level outcomes were assessed. Interventions: Staff nurse delirium education and a nurse-driven delirium screening protocol were implemented. Results: No change in nursing knowledge occurred pre/postintervention. Falls, falls with injury, and restraint and sitter usage decreased. Changes in length of stay varied over the intervention period. The trend to discharge to home increased, while the trend to discharge to skilled nursing care decreased. Conclusions: Formal delirium screening protocols may add organizational value by positively impacting patient outcomes.

Implementing a Delirium Risk Stratification Tool and Rounds to Identify and Prevent Delirium in Hospitalized Older Adults

“…This project found an improvement in nurses' detection of delirium and a reduction in LOS and SNF placement. While literature illustrates an improvement in LOS and SNF discharges after implementing a multiapproach delirium prevention initiative, 9,10,14 there is little published literature in regard to improving nurses' delirium detection rates. Therefore, this project adds to the literature by sharing another way of evaluating a delirium prevention initiative.…”

“…Early recognition can also help reduce the risk of cognitive and/or functional decline and decrease mortality in older adults 6,7. Prior studies indicate that implementing staff education, evidence-based prevention and treatment protocols, and geriatric or psychiatric consultation to manage delirium in high-risk patients can reduce delirium incidence, hospital LOS, and the number of patients discharged to an SNF 9–22…”

“…6,7 Prior studies indicate that implementing staff education, evidence-based prevention and treatment protocols, and geriatric or psychiatric consultation to manage delirium in high-risk patients can reduce delirium incidence, hospital LOS, and the number of patients discharged to an SNF. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] To obtain baseline data on nurses' recognition of delirium, the Geriatric Clinical Nurse Leader www.jncqjournal.com 159…”