Nurse-Driven Delirium Prevention and Intervention Project

Grant Application

Erin Flanagan, MSN, and Stasa Tadic, MD, UPMC Mercy

Proposed Innovation

Delirium is a sudden onset of confusion ,which is a very prevalent condition in hospitalized elderly patients, including patients with dementia. Although associated with adverse outcomes, delirium is a preventable and reversible condition if identified and treated early.

This innovative project aims to establish a delirium identification and intervention protocol to guide nurses and physicians in a treatment and prevention plan.

Improvements in Action

This quality improvement project focuses on assessments (Confusion Assessment Measure, or CAM) to evaluate patients and interventions to track patient outcomes and cost savings — from admission to discharge and beyond. The information will be used to package and streamline rollout of the project to other departments.

The main goal of this project is to standardize care of patients who are at risk for or showing signs of delirium. The new clinical process will include special guidelines for determining the best times to conduct CAM assessments and best location for documentation and tracking interventions. Pocket cards, charge nurse tracking forms, and other tools will be provided to staff during training.

Outcomes

Having an established protocol to guide treatment will lead to early identification and intervention, resulting in an anticipated decrease in patients who develop delirium during their hospital stay. It also is expected to ease symptoms in those patients presenting with symptoms of delirium. Other potential benefits include a reduction in length of stay, decreased use of opioids and antipsychotics, fewer patient falls, decreased use of restraints, plus an increase in the number of patients returning home safely instead of transferring to a skilled nursing facility.