Preventing delirium in the Acute Care setting using a volunteer program

Purpose:
Delirium is an acute disturbance of consciousness with reduced ability to focus, sustain or shift attention. It is associated with increased morbidity & mortality. The loss of function and independence represents frequent and unfortunate outcomes for patients, and ultimately their families.

Significance:
35% of the US population aged ≥65 years are hospitalized annually, account for 50% of inpatient days, and $148.2 billion in annual Medicare expenditures. Disability occurs in >30% older patients. At one year <50% have recovered, and many experience high rates of advanced placement and death.

Strategy and Implementation:
The Hospital Elder Life Program was developed by Dr. Sharon Inouye. It is an innovative, unique strategy that provides an enhanced,team-based, patient-center approach to delirium prevention for patients at risk at Park Nicollet Methodist Hospital. We are the only HELP site in Minnesota. This team, with a focus on geriatric care, consists of an Elder Life Nurse Specialist(coordinator), unit staff including nurses, MD's and others, and a team of well trained volunteers. The volunteers deliver activities to identified patients 3 times per day, 7 days per week. All patients at Park Nicollet Methodist Hospital,≥70 years of age, are screened by nurses, using the CAM; Confusion Assessment Method. Enrolled patient activities are targeted and standardized to the patients needs and are based on six risk factors. Risk factors include cognitive & sensory impairment, mobility, dehydration, sleep disturbances and polypharmacy. The program coordinator collaborates with physicians for guidance.

Evaluation:
Program success is measured in number of patients visited, number of visit per patient, and number of volunteers providing those visits. Patient outcomes are measured in CAM - maintenance rate, demonstrating the ultimate goal of patients remaining free from delirium during their hospitalization.

Implications for Practice:
Our delirium initiative included "Recognize It, Treat It, Document It and Prevent It". Training nursing to perform the CAM assessment allowed for identification of appropriate patients, and was essential for a prevention program success.