The Impact of Geriatric Resource Nurses on the Outcomes of Patients with Hospital Acquired Delirium

Purpose:
Staff nurses were educated to serve as Geriatric Resource Nurses. They were taught evidenced-based practices and were given the opportunity to choose an area of focus on their unit. Our GRN team chose nursing interventions that can improve outcomes of patients with hospital-acquired delirium.

Significance:
Delirium is a common reversible syndrome associated with increased hospital costs & LOS, increased morbidity & mortality with a 6.9 billion annual cost to Medicare and a place on CMS's proposed no-pay list of hospital acquired conditions. NDNQI indicators show value in nurses promoting quality care.

Strategy and Implementation:
Through the GRN studies, we knew that delirium could be prevented or managed with a few simple interventions. We needed to come up with a tool that could do several things at once: identify clients with or at risk for delirium, educate staff, and offer undemanding, practical solutions. To educate staff about the prevalence of delirium, the risk factors involved, and the evidence-based interventions available, we developed a nursing care plan and a structured focus note. The nursing care plan offers knowledge about how to identify those at risk and how to intervene once identified to prevent or manage delirium using a structured approach easily individualized to each patient. The structured focus note offers a fast and easy way to address the problem, to know what actions to take, to know the expected outcomes and response, while being able to add more insightful information as needed. It also lends itself to documentation of a growing problem.

Evaluation:
On all patients ages 65 or older, inattentiveness, hyper-vigilance, insomnia, lethargy, and restlessness/agitation was measured pre and post intervention. Immobility, indwelling catheter-use, and restraint-use were also measured pre and post intervention. All areas improved post intervention.

Implications for Practice:
Staff learned risk factors & evidence-based interventions and experienced the ease with which they could be implemented. The positive outcomes for managing and preventing delirium in the elderly increased nurse satisfaction. We have seen through the NDNQI indicators the value of nurse satisfaction.