We can Do it: Nursing Educational Intervention to Increase Delirium Documentation

Stephanie Chow

doi:10.4172/2167-7182.s3-002

Abstract

Background/Objectives: Delirium is a widely recognized complication during hospitalization, but poorly documented. We examined the effectiveness of a geriatrician-guided delirium training intervention to increase nurses’ delirium documentation, knowledge, and self- confidence. Design: Prospective cohort study Setting: Orthopedic surgical inpatient unit Participants: Twenty-six nursing staff Intervention: Nurses participated in a geriatrician-guided delirium training intervention. Each nurse received two 45-minute didactic sessions on delirium causes, screening, and prevention using the Confusion Assessment Method (CAM). Measurements: Nursing delirium documentation pre- and post-educational intervention was determined during the months of March and June 2013. Nurses also completed a pre- and 3-month post-interventional survey to assess confidence and knowledge of delirium detection. Results: Nursing mean age was 46 years, with 17 years of experience. Patients with CAM documentation increased significantly post-intervention from 13 to 91% (p<0.001). On average, rate of nursing CAM documentation per shift increased from 5.5 to 70.8%, (p<0.001). Post-interventional nursing knowledge scores significantly improved from 44 to 73% correct (p<0.001). As compared to pre-intervention, nurses scored significantly higher on number of delirium risk factors from 32 to 71% (p<0.001), medications to avoid in the elderly from 20 to 70% (p<0.001), and correct management strategies for patients with delirium from 52 to 84% (p<0.001). Nurses’ confidence in detecting delirium increased significantly post-intervention from 7.8 to 8.6 points out of a 10-point scale (p=0.021). Conclusion: Nursing knowledge and documentation of delirium using the CAM, as well as nursing confidence in identifying delirium all significantly increased after formal geriatrician-guided educational intervention.

Highlights

Delirium is widely recognized as a significant and possibly preventable complication during hospitalization, but is poorly documented in the electronic medical record [1]
As compared to pre-intervention, nurses scored significantly higher on number of delirium risk factors from 32 to 71% (p
In our study of an orthopedic surgical inpatient unit, we examined the effectiveness of a geriatricianguided delirium training intervention using the Confusion Assessment Method (CAM) to increase nurses’ delirium documentation

Summary

Introduction

Delirium is widely recognized as a significant and possibly preventable complication during hospitalization, but is poorly documented in the electronic medical record [1]. If left untreated delirium is associated with serious health and quality-of-life consequences, including increased risk of morbidity and mortality, as well as greater functional dependence after discharge. Overall delirium incidence ranges widely, from 14-56% of hospitalized older patients, with a reported 9-65% incidence in those patients undergoing orthopedic fracture repair [2,3,4,5,6]. Complications of delirium include longer hospital stays, prolonged cognitive impairment and significant emotional distress to the patient and caregivers [7]. The financial burden of delirium is staggering, totalling more than $16,303 to $64,421 per patient, with direct 1-year health costs estimated to exceed $143 to $152 billion [8,9]. The United States has seen rapid growth of multicomponent interventional and educational programs aimed to prevent, screen, and reduce delirium occurrence and its complications [6,10]

Results

Discussion

Conclusion