Prevention of postoperative delirium - A prospective nurse-led intervention on surgical wards in a general hospital

Abstract

ObjectiveDelirium is a frequent postoperative complication in older and cognitively impaired patients in general hospitals. Delirium is associated with prolonged hospital stay as well as with an increased risk of nursing home placement after discharge. We wanted to study whether the implementation of a specialized delirium nurse on a surgical ward leads to a reduction in the frequency of postoperative delirium.MethodsIn an open-label study on two surgical wards of a general hospital, first the prevalence rate of postoperative delirium in patients older than 70 years was assessed (March to August 2011). During the following intervention phase (September 2011 to June 2012), a trained geriatric nurse implemented delirium-preventative measures in accordance with the Hospital Elder Life Program (HELP). The second surgical ward provided standard treatment as usual as an in-house control.ResultsOverall 20.2%, 95% CI [14.6, 26.4] of patients on both wards without special intervention developed postoperative delirium. By implementing preoperative screening measures and specific interventions by a delirium nurse, the incidence of postoperative delirium was reduced to 4.9%, 95% CI [0.0, 11.5]. The interventions were validation, improving sleep quality, cognitive activation, early mobilisation, improving sensory perception and optimising food and fluid intake. Most important predictors of postoperative delirium were Mini Mental Status Exam results, age and preoperative infection.ConclusionThe establishment of a specialised delirium nurse as well as the implementation of simple preoperative care measures increased postoperative attention, cognitive activation and is associated significantly with reducing risk of postoperative delirium in older and cognitively impaired inpatients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

An observational study of older patient specialling in acute hospital settings

“…Quantitative findings showed that delirium (83.3%) was the major indication for specialling. This is consistent with other studies that have identified specialling as a common strategy for management of older patients with delirium (Dewing, 2013;Kratz, Heinrich, Schlauß, & Diefenbacher, 2015;Wood et al, 2018). While early rec- These specialling practices elicited positive responses such as pleasure, affection and helpfulness from the patients specialled in this study.…”

Inzidenz und Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- und Facharztpraxen

“…In dieser Studie haben wir nicht geprüft, ob mit der Diagnosestellung, bestimmte Delir auslösende Medikamente abgesetzt wurden. Darüber hinaus erlaubte der verwendete Datensatz nicht zu beurteilen, wie lang das Delir dauerte, ob die Symptomatik in einem zeitlichen Zusammenhang mit einem Krankenhausaufenthalt stand, ob und in welchen Umfang nicht-medikamentöse Anti-Delir-Strategien verwendet wurden [28,41]. Schließlich ist zu berücksichtigen, dass Neuroleptika und Benzodiazepine unter bestimmten Bedingungen, z.…”

Strategies to improve postoperative brain health in geriatric patients

“…A study in surgical wards of a hospital in Germany found that 20.8 percent of patients over the age of 70 developed postoperative delirium; however, when nursing personnel implemented a series of interventions, only 4.9 percent of patients developed the condition. 4 The authors of the study noted that trained nursing personnel can play an active role in delirium prophylaxis. In addition to the interventions to improve sensory stimulation mentioned above, the study's interventions also included early mobilization, improved fluid and nutritional intake, improved sleep (e.g., adjusting lighting to support regular sleep-wake cycles), and cognitive activation (e.g., reminiscence and memory therapy).…”

“…In addition to the interventions to improve sensory stimulation mentioned above, the study's interventions also included early mobilization, improved fluid and nutritional intake, improved sleep (e.g., adjusting lighting to support regular sleep-wake cycles), and cognitive activation (e.g., reminiscence and memory therapy). 4 Several medications exacerbate postoperative delirium and care providers should avoid prescribing them in geriatric populations. Classes of medications including anticholinergic medications, sedativehypnotics, corticosteroids, and meperidine can increase a geriatric surgical patient's risk of delirium twofold.…”