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

Fick, Donna M.

doi:10.3928/00989134-20180713-03

Cited by 11 publications

(10 citation statements)

References 9 publications

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“…Die Ergebnisse unterstreichen die Notwendigkeit, das gesamte medizinische Personal, einschließlich der Ärzte in der Akutversorgung, für stationäre Patienten mit kognitiven Beeinträchtigungen zu sensibilisieren. Die Behandlung von kognitiven Beeinträchtigungen wie Delir liegt in der Verantwortung des gesamten Teams [8]. Für eine patientenzentrierte Versorgung und einen gemeinsamen Versorgungsplan mit gemeinsam vereinbarten Zielen müssen sich Verfahren für Screening, Diagnose und Kodierung von kognitiven Beeinträchtigungen in den Krankenhäusern entwickeln [19].…”

Section: Schlussfolgerungenunclassified

Prevalence of cognitive impairments in acute nursing care—Analysis and comparison of routine data

Mai

Flerchinger

2020

Z Gerontol Geriat

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Zusammenfassung Hintergrund Aufgrund des demografischen Wandels ist von einer zunehmenden Prävalenz stationärer Patienten mit kognitiven Beeinträchtigungen auszugehen. Für eine bestmögliche Versorgung gilt es, diese Patientengruppe mit einem routinemäßigen Verfahren frühzeitig zu erkennen. Methode Die aktuelle Studie untersuchte die Prävalenzrate von kognitiven Beeinträchtigungen bei stationären Patienten >65 Jahre, die mit dem Mini-Mental-Status-Test (MMST) während der pflegerischen Aufnahme untersucht wurden. Anhand der Screeningquote wurde die Bereitschaft von Pflegekräften, den MMST als Routineinstrument zu verwenden, überprüft. Die Quote wurde zudem mit der Anzahl der kodierten F‑Diagnosen der ICD-10-GM verglichen. Diese retrospektive Studie wurde vom Oktober 2018 bis März 2019 an einer Universitätsklinik durchgeführt. Ergebnisse Von 7311 stationären Patienten >65 Jahre wurden 11,7 % gescreent. Die Prävalenz kognitiver Beeinträchtigungen betrug 20,7 % und war höher als die Prävalenzrate von Demenz und Delir aufgrund medizinischer Diagnosen (p < 0,001). Mit 11,7 % ist die Bereitschaft des Pflegepersonals, den MMST zur Einschätzung kognitiver Beeinträchtigungen während der Patientenaufnahmen einzusetzen, gering. Diskussion Die höhere Prävalenz bestätigt die Notwendigkeit, Patienten mit kognitiven Störungen zu erkennen. Die geringe Bereitschaft, den MMST anzuwenden, legt jedoch nahe, dass zum einen ein kürzeres Instrument verwendet und zum anderen Pflegenden mehr Informationen zu kognitiv beeinträchtigten Patienten vermittelt werden sollten.

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Section: Schlussfolgerungenunclassified

Prevalence of cognitive impairments in acute nursing care—Analysis and comparison of routine data

Mai

Flerchinger

2020

Z Gerontol Geriat

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“…Delirium in older adults is considered a medical emergency owing to a wide range of negative outcomes, such as new onset or deterioration of dementia, higher mortality, as well as higher risks of falls, pressure injury, and functional decline (Fick, 2018; Moon & Park, 2018; Reynish et al, 2017). Therefore, early recognition followed by prompt management is critical to delirium care (O'Mahony et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Can multifaceted educational intervention improve clinical practice and patient outcomes regarding delirium in nursing homes?

Jeong

Chang

2021

Japan Journal Nursing Sci

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Aim We aimed to develop and evaluate a multifaceted and evidence‐based delirium educational program for practitioners in nursing home settings. Methods A pre‐ and posttest comparison group design was employed. The recruited practitioners included nurses and care workers from two nursing homes. The intervention group (n = 51) received the developed delirium educational program for 3 weeks, whereas the control group (n = 23) received a delirium handbook. We examined pre‐ and posttest differences in the scores for delirium knowledge and confidence in providing delirium care. We also examined the nurses' ability to clinically detect delirium in patients and delirium incidence for 8‐week periods both before and after the intervention. Results There were significant improvements in the participants' aptitudes (delirium knowledge and confidence in providing delirium care) and clinical practice (ability to clinically detect delirium in the patients) only in the intervention group; however, there were no significant differences in patient outcomes (incidence of delirium) between either group. Additionally, it was observed that the nurses' improved understanding of distinct clinical features of delirium, such as acute change or fluctuation, was the key factor that directly affected the success of delirium screening. Conclusions This study revealed that implementation of a multifaceted and evidence‐based delirium educational program for practitioners in nursing home settings was effective in promoting the knowledge, confidence, and ability to detect delirium. The developed program can also be implemented in settings where most patients are older individuals, such as geriatric care units, or long‐term care hospitals.

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“…Decline in cognition after admission is multi-factorial and may relate to medical conditions, functional deterioration, pharmacological treatments, or the environment itself [1,2]. Although fluctuating cognition is increasingly considered to be a vital sign, particularly in older adults [3], few short, valid, and reliable cognitive tests are available in hospital to routinely monitor changes in cognitive function [4], where the prevalence of delirium approaches 20% [5] and major neurocognitive disorders such as dementia approach 50% [6,7]. Reflecting this, delirium and dementia are frequently unrecognized in hospitals [2,8].…”

Section: Introductionmentioning

confidence: 99%

“…Another challenge is how to allocate responsibility for the administration of these instruments in routine clinical practice. While it is suggested that nursing staff may be best placed to monitor a CVS [3], the feasibility of this is unclear. Evidence suggests that healthcare professionals are more receptive to using brief and easy-to-administer tools [14,15].…”

Section: Introductionmentioning

confidence: 99%

Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory

Nicholas

Ó’Caoimh

Gao

et al. 2019

IJERPH

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Although there is a high prevalence of delirium and cognitive impairment among hospitalised older adults, short, reliable cognitive measures are rarely used to monitor cognition and potentially alert healthcare professionals to early changes that might signal delirium. We evaluated the reliability, responsiveness, and feasibility of logical memory (LM), immediate verbal recall of a short story, compared to brief tests of attention as a bedside “cognitive vital sign” (CVS). Trained nursing staff performed twice-daily cognitive assessments on 84 clinically stable inpatients in two geriatric units over 3–5 consecutive days using LM and short tests of attention and orientation including months of the year backwards. Scores were compared to those of an expert rater. Inter-rater reliability was excellent with correlation coefficients for LM increasing from r = 0.87 on day 1 to r = 0.97 by day 4 (p < 0.0001). A diurnal fluctuation of two points from a total of 30 was deemed acceptable in clinically stable patients. LM scores were statistically similar (p = 0.98) with repeated testing (suggesting no learning effect). All nurses reported that LM was feasible to score routinely. LM is a reliable measure of cognition showing diurnal variation but minimal learning effects. Further study is required to define the properties of an ideal CVS test, though LM may satisfy these.

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

Cited by 11 publications

References 9 publications

Prevalence of cognitive impairments in acute nursing care—Analysis and comparison of routine data

Prevalence of cognitive impairments in acute nursing care—Analysis and comparison of routine data

Can multifaceted educational intervention improve clinical practice and patient outcomes regarding delirium in nursing homes?

Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory

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