Theses and Dissertations at Montana State University (MSU)
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Item Implementing a delirium screening tool for older acute hip fracture patients in the emergency care setting(Montana State University - Bozeman, College of Nursing, 2023) Feerer, Ashley Jordan; Chairperson, Graduate Committee: Elizabeth A. JohnsonDelirium is associated with consequences such as prolonged hospital duration, accelerated functional and cognitive decline, increased mortality, high healthcare costs, and loss of independence. The Geriatric Emergency Guidelines recommend using the screening tools, Delirium Triage Screen (DTS) and Brief Confusion Assessment Method (bCAM), to identify patients with delirium. The Emergency Department (ED) and non-ICU units at a level III trauma center in Southwest Montana lack formal delirium prevention policies and protocols, including delirium screening tools and management following a positive result. This quality improvement (QI) project was designed to identify delirium among hip fracture patients aged 65 or greater in the emergency setting by implementing the delirium screening tools DTS and bCAM. Three Plan-Do-Study-Act cycles every 2 weeks with qualitative surveys, educational video for emergency department registered nurses (RNs), and electronic health record (EHR) data were used to evaluate the success of this QI project. Interventions included building the delirium screening tool DTS/bCAM in the EHR charting system and creating and distributing a nurse education video with a survey to identify learning outcomes and process feedback. Total sample size was 15 emergency RNs who responded to surveys collected over a 4-week period. There were five emergency department patients who met criteria. Three of the five patients were screened for delirium. The ED has adopted the delirium screening tool procedure and the practice change has been accepted by the ED RNs.Item Integrating delirium screening and nonpharmacologic interventions in a rural progressive care unit(Montana State University - Bozeman, College of Nursing, 2022) Miller, Christine Kelli; Chairperson, Graduate Committee: Lisa SluderScreening for delirium in the hospital is often inconsistent in areas outside of the intensive care unit (ICU). Delirium is often missed in this patient population, and this negatively affects these patients. Research indicated that hospital acquired delirium can increase morbidity and mortality and impose a financial burden on the health care system. This quality improvement project aimed to implement delirium screening with subsequent nonpharmacologic interventions for those who screened positive for delirium. The setting was a rural progressive care unit in a nonprofit hospital in the Pacific Northwest. Research suggested delirium prevention utilizing nonpharmacologic interventions was the foundation for management. The interventions proven to be effective in delirium management that were utilized in this project included routine screening for delirium, bowel management, adequate nutrition and hydration, sleep hygiene, frequent reorientation, and mobility. This DNP project included daily screening for delirium using the Confusion Assessment Method (CAM) on patients who were hospitalized for two or more nights and a nonpharmacologic delirium order set for patients who screened positive for delirium. The results demonstrated increased clinical awareness and early identification of delirium; however, the goals of screening for delirium using the CAM assessment 80% of the time and ordering the Prevent Delirium order set on 50% of patients who screened positive for delirium were not met. Although the goals for this project were not met, the results indicated that the patients who were screened scored positive for delirium 7.2% of the time. Furthermore, the results revealed a total of 14.2% of the patients in the progressive care unit screened positive for delirium over the five-week implementation period. This finding was consistent with the literature that patients in units outside of the ICU were found to be positive for delirium during their hospitalization. Providing evidence-based delirium screening and delirium prevention strategies has the potential to increase patient outcomes and decrease the financial burden by reducing delirium and its associated negative sequelae.