Implementing a delirium screening tool for older acute hip fracture patients in the emergency care setting

Abstract

Delirium 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.