Delirium Screening: The Next Nurse Sensitive Indicator?

Purpose:
Prevention and treatment of delirium is nurse sensitive. We did not have a process in place to routinely screen patients for delirium. This is a common finding across the country. Our goal was to implement delirium screening on all patients and standardize preventive nursing practices on our unit.

Significance:
Delirium increases length of stay, mortality, and cost. Patients with delirium who survive have long term cognitive dysfunction. This affects quality of life and performance of daily activities. Screening and treatment for delirium in hospitalized patients can help attenuate these adverse outcomes.

Strategy and Implementation:
Our initial goal was to educate the nursing staff on what delirium is and how it affects patient outcomes. This helped us attain "buy-in" from staff. Next we reviewed the literature to identify an appropriate evidence based screening tool. Key stakeholders were identified and delirium "superscreeners" on each shift were recruited to help implement and sustain the practice change. An initial pilot of approximately 2 weeks included delirium screening on all ICU patients twice daily by the super screeners. The unit clinical nurse specialist and other leaders audited the screens to establish inter-rater reliability before rolling out daily screening to all staff members. Once this practice was hardwired, nursing practices were identified via the literature to prevent and treat delirium. An interdisciplinary team was formed and an order set was developed to prevent and treat patients with delirium.

Evaluation:
The CNS tracked daily incidence of patients with delirium, nursing preventive practices, and use of the order set over a six month period. Our initial findings have been promising showing a decrease in daily incidence of delirium from 42% to 23%.

Implications for Practice:
Long term outcomes such as length of stay, mortality and cost may demonstrate the impact nursing practice has on patient care.Sharing our practices and findings may encourage increased use of delirium screening nationwide, and perhaps be considered as something that could be benchmarked nationally.