A Multi‐disciplinary Team Approach for Educating Providers to Recognize Delirium in the Post Anesthesia Care Unit

Abstract

AbstractBackgroundPostoperative delirium is common in older adults and has significant associated morbidity and mortality. However, screening is rarely performed in the post anesthesia care unit (PACU). For this reason, clinical researchers of delirium and a tertiary care interdisciplinary delirium Task Force Team proposed to address this area of patient safety.MethodA multidisciplinary team met to complete 3 hospital learning objectives. First, to develop an educational toolkit on PACU delirium identification with feedback from hospital stakeholders on topics to be trained, implementation into medical records, and finalizing training videos/powerpoint/quiz modules. Second, to train every PACU nurse on delirium identification. An EPIC form was created with detailed instructions for completing and documenting the CAM‐ICU and included in the PACU discharge checklist. All PACU nursing staff were assigned the module, and delirium screening was made mandatory for all patients aged 65 years or older. Following module assignment, perceived value, satisfaction, and barriers were surveyed to inform modification of training and implementation. Third, delirium screening rates were monitored.ResultsNurses (n = 110) were assigned postoperative delirium training modules across 3 PACUs starting July 2022 with a 2‐week deadline. Training completion rate was 83% after 3 months. Nurses provided positive feedback on the importance of delirium. Compliance in delirium screening in the PACU was low (<10%). After meeting with nursing staff to hear concerns/barriers to training and implementation, 1 on 1 training with research staff was initiated and all PACU nursing staff completed additional training between September and October. Before project implementation, no delirium screening was performed in the PACU. Over 3 months following completion of training, of 683 patients aged 65 years and older discharged from the PACU, 83 (12%) had delirium screening documented, and 0% were flagged as positive. Rate of screening differed by surgical service and hospital location.ConclusionThis hospital learning study documents the challenges and promise of implementing a PACU delirium screening program in a tertiary care academic medical center. We present data on improved delirium recognition at the hospital level, but variation in compliance rates by surgical service. Future research needs to examine reasons for variable delirium compliance screening.