Integrating delirium screening and nonpharmacologic interventions in a rural progressive care unit
Miller, Christine Kelli
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Screening 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.