Sustained delirium reduction in an inpatient neuroscience unit

Abstract

BackgroundDelirium is described as acute brain dysfunction that often fluctuates throughout the day and is highly prevalent in hospitalized adults. Delirium negatively affects patient outcomes with consequences including decreased cognitive functioning and increased mortality and healthcare costs. Furthermore, neurological patients are at increased risk for developing delirium due to their underlying diagnoses.PurposeThe purpose of this evidence‐based practice project was to evaluate the long‐term impact of nursing education and use of trained volunteers to prevent the development of delirium in an inpatient neuroscience unit.Implementation PlanThis was a pre–post designed evidence‐based practice project to educate and prioritize nursing care interventions for delirium prevention compared to a delirium management framework. The interventions included delirium education for nurses and nursing assistants along with the development of a specialized volunteer program to implement non‐pharmacological, multi‐component delirium prevention interventions. Long‐term sustainment and enculturation occurred over the subsequent year.OutcomesThe baseline data collection period included 2520 patients. The intervention period included 4515 patients, with both groups being similar in age, race, gender, and length of stay. The total number of patients with a discharge diagnosis of delirium decreased from 29.2% to 19.8% (p < .001). Fewer patients in the intervention group were discharged to a skilled nursing facility (p < .001) and other post‐acute facility (p = .008), along with more patients being discharged to home care (p < .001).Linking Evidence to ActionThis evidence‐based practice project demonstrates long‐term sustained reduction of delirium in the neuroscience population. Despite the challenges during the COVID‐19 pandemic, delirium prevention strategies were found to be effective in decreasing the rate at which patients develop delirium.

Delirium and Its Associations with Critical Care Utilizations and Outcomes at the Time of Hospital Discharge in Patients with Acute Brain Injury

“…Our study finds an overall prevalence of delirium to be 27%. When we compared our numbers with those published in the literature, we found that our overall rates are within the pooled rate of 12-43% [19,23,24] and higher than that published by von Hofen-Hohloch and colleagues (18.7%) [25]. Our numbers are higher (26.3% vs. 18.3%), as published by Kozak and colleagues in AIS patients not admitted to an ICU [26].…”

“…The 4AT scoring has been proposed as a simple scoring test in geriatric patients, especially those with dementia and who are non-English speaking [48]. Education for neurocritical care clinicians (nurses) has yielded positive results in a sustained reduction in the rates of delirium [23]. Additionally, benchmarking with other healthcare institutions and reviewing the published literature can help identify best practices and ensure that care aligns with evidence-based guidelines.…”