DELIRIUM SUPERIMPOSED ON DEMENTIA IN POST-ACUTE CARE: NURSE DOCUMENTATION OF SYMPTOMS AND INTERVENTIONS

Abstract

Abstract Delirium is common in older adults and across settings of care, including post-acute care (PAC). Nurses have an important role in identifying, preventing and managing delirium. Even though best practice guidelines highlight the need to accurately document delirium and to deliver non-pharmacological, nurse-driven interventions, it is unclear how this is done in PAC. The aim of this research was two-fold: 1) to describe how nurses document DSD symptoms in PAC nursing notes and 2) to determine if appropriate non-pharmacological nursing interventions are included in their documentation when DSD is present. The sample (N=281) was drawn from a large, single-blinded randomized controlled trial (Recreational Stimulation For Elders As A Vehicle To Resolve DSD (Reserve-DSD) across 8 facilities. Participants tended to be white, female, and had a high-school education. A total of 115 participants (40.6%) had full delirium per the CAM upon admission to PAC, while the remainder 168 (59.4%) had subsyndromal delirium. All had a baseline of dementia. Symptoms of ‘Confusion or Acute Confusion’ were reported for more than 50% of patients. Approximately 90% of had the symptom ‘Confusion or Acute Confusion’ documented and this was also the most commonly documented symptom for which a nursing-driven intervention was provided. Overall delirium symptoms and interventions were poorly documented by nurses. Implications for future research and practice include understanding how the pandemic and subsequent resource deprivations impacted delirium documentation and intervention in this setting. Also there is a need for expanded nurse and other healthcare provider education.