A Nurse-Led Delirium Prevention Program for Hospitalized Older Adults
Background: Delirium, an acute decline in cognition and attention, is a common and severe problem for hospitalized older adults, with incidence rates ranging from 11% to 56%, and 1.5 to 4.0-fold increased risk of death. Despite its multifaceted nature, delirium is preventable in 30% to 40% cases. A California academic community hospital experienced a higher incidence of delirium (30% to 40%) in adult non-critical care units as compared to delirium rates (11% to 29%) in similar hospital settings. The higher rates of delirium were believed to be due to fragmented, inconsistent, and non-individualized delirium care. Purpose/Objectives: The purpose of this evidence-based, quality improvement project was to determine whether a nurse-led Delirium Prevention Bundle (DPB) when compared to usual care, reduces delirium incidence in hospitalized geriatric patients. Method: The project was a two-group, pre-post design using the nurse-led DPB educational intervention for nurses. The project was implemented in two stages: 1) an educational session for nurses on completing the DPB including the Delirium Risk Factor Identification (DRFI) tool, targeted delirium prevention strategies (based on the Hospital Elder Life Program), and nursing documentation; and 2) the DPB implementation on a 26-bed geriatric unit at a 250-bed academic community medical center. Baseline data on delirium incidence rates were collected on eligible patients on the geriatric unit for one month before the intervention and prospectively on patients who were eligible following the educational intervention. Demographic data on eligible patients and unit nursing staff as well as nurse knowledge of delirium and adherence to the DPB were collected. Statistical analyses included descriptive statistics, t-tests, and chi-square test. Results: implementation of nursing education of the DPB, the addition of the DRFI tool, and documentation template in the hospital Electronic Health Record, was effective in reducing delirium incidence rate from 16% to 14% (p =<.001) and improving documentation compliance from <1% to 17%. Nurse delirium knowledge was also improved significantly (pre-test mean 80.0, post-test mean 94.3, p=.029). Conclusion: Nursing education utilizing the DPB is an effective approach in increasing nurse awareness of preventive care for delirium and decreasing incident delirium in this population.