Improving Dementia Care Practices: Implementation of an Innovative Interprofessional Delirium Prevention Program for Hospitalized Older Adults.

Abstract

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. Delirium in older adults with preexisting Dementia is prevalent. Delirium may worsen the cognitive decline, prognosis, and long-term outcomes of dementia. Despite its multifaceted nature, delirium is preventable in 30% to 40% of 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. This evidence-based, quality improvement project was a two-group, pre-post design using the educational intervention. The project was implemented in two stages: 1) education on completing the Delirium Prevention Bundle (DPB) including the Delirium Risk Factor Identification (DRFI) tool, targeted delirium prevention strategies, and documentation; and 2) the DPB implementation on a 26-bed geriatric unit at a 250-bed academic community medical center. Demographic data on patients and staff were collected. Staff delirium knowledge was assessed. Data on delirium incidence rate were collected pre-post-intervention. Statistical analyses included descriptive statistics, t-tests, and chi2 test RESULT: Implementation of the DPB education, 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). Interprofessional education utilizing the DPB is an effective approach in increasing awareness of preventive care for delirium and decreasing incident delirium in this population.