Pilot Study of a Two-Step Delirium Detection Protocol Administered By Certified Nursing Assistants, Physicians, and Registered Nurses

Abstract

The feasibility and acceptability of a two-step screening protocol for delirium identification was pilot tested. Step 1, a screening tool, comprises two items: "Please tell me the day of the week," and "Please tell me the months of the year backwards starting with December." If either/both items are incorrect, Step 2, a 3-minute diagnostic assessment, follows. Trained researchers enrolled 24 hospitalized older adults and identified 22% to be delirious after a reference standard assessment. Thereafter, physicians and RNs completed the two-step protocol, whereas certified nursing assistants (CNAs) completed the screener only, on the same patients. All three clinical assessments were successfully completed in 100% of enrolled participants and within the target 2-hour time window in 91%. The screener and two-step protocol achieved high sensitivities and specificities in RNs, CNAs, and physicians. Qualitative information on barriers to and facilitators of implementation was also collected. Nurses and other clinicians can feasibly implement this ultra-brief screener and two-step protocol, which holds promise to improve delirium identification. [Journal of Gerontological Nursing, 44(5), 18-24.].

Comparative Accuracy and Efficiency of Four Delirium Screening Protocols

“…It consisted of 201 inpatients, aged 75 years or older, on general medicine units at a large academic medical center in Boston, MA. The READI study is designed to assess the feasibility, test characteristics, time required, and cost of administration of a two‐step protocol for delirium identification consisting of the UB‐2, followed by the 3D‐CAM in “positives,” as administered by physicians, nurses, and nursing assistants 11 . It prospectively enrolled participants from the same medical center as 3D‐CAM, and from a smaller rural community hospital in Pennsylvania.…”

“…The READI study is designed to assess the feasibility, test characteristics, time required, and cost of administration of a two-step protocol for delirium identification consisting of the UB-2, followed by the 3D-CAM in "positives," as administered by physicians, nurses, and nursing assistants. 11 It prospectively enrolled participants from the same medical center as 3D-CAM, and from a smaller rural community hospital in Pennsylvania. Inclusion criteria were age 70 years and older, admission to general medicine service, expected length of hospital stay of 3 or more days, and ability to communicate adequately in English.…”

Family caregiver's experience of caring for an older adult with delirium: A systematic review

“…This calls for the involvement of family caregivers as care partners in delirium management. In addition, family caregivers may be able to use tools such as Family‐Confusion Assessment Method (FAM‐CAM: screening instrument to heighten detection of delirium features by family members), the UB‐2 (ultra‐brief screening instrument that has been administered by nursing assistants) or MENTOR_D (programme where nurses mentor family caregivers about delirium management behaviours) to better assist in the early detection of delirium (Inouye, Puelle, Saczynski, & Steis, 2011; Fick et al., 2015; Fick et al., 2018; Mailhot et al., 2017). The review also emphasised family caregivers exhibiting higher levels of distress associated with the symptoms of delirium (Bull, 2011; Buss et al., 2007; Martins et al., 2017; Morandi et al., 2015).…”

“…to better assist in the early detection of delirium (Inouye, Puelle, Saczynski, & Steis, 2011;Fick et al, 2015;Fick et al, 2018;Mailhot et al, 2017). The review also emphasised family caregivers exhibiting higher levels of distress associated with the symptoms of delirium (Bull, 2011;Buss et al, 2007;Martins et al, 2017;Morandi et al, 2015).…”

The Critical Vital Sign of Cognitive Health and Delirium: Whose Responsibility Is It?

“…Many assessment tools are available to assess for delirium and delirium superimposed on dementia. Currently, I am part of a team that is pilot testing a 36-second screen for delirium that has more than 90% sensitivity to detect delirium and delirium superimposed on dementia and can be performed easily by nursing assistants, RNs, and physicians (Fick et al, 2015;Fick et al, 2018). Th e Hospital Elder Life Program website also has resources for screening and diagnosing delirium and for family members and patients (access https://www.…”