Improving Patient Safety Through the Prevention and Treatment of Delirium

Purpose:
Newark Wayne Community Hospital is a 120 bed rural hospital with 65% of the inpatients are older than 65 years of age. Many patient safety issues are impacted by the high rate of delirium in our patients.

Significance:
Delirium, an acute decline in attention and cognition, represents a common and severe problem for hospitalized patients. Delirium commonly initiates a cascade of events resulting in loss of independence, increased mortality, increased cost, and a poor hospital experience.

Strategy and Implementation:
Our nursing staff implemented a protocol focused strictly on the geriatric population. Our goals included keeping the patient engaged and their body and mind active while hospitalized, early recognition of delirium; preventing sleep cycle disruption; and prevention of falls. The interventions that were implemented included: •Education of team members to ensure standardization and recognition of delirium and risk factors. •The use of telemedicine to allow patients to be seen via web-based technology by a geriatric specialist. •Improving the falls prevention program with an improved risk assessment and use of red socks to identify patients with potential for falls. •Implementing an "Activity Cart" that offered various activities to keep the patients mind and spirit engaged. •A PT/OT program "Move to Improve" to keep the patients physically active. •The use of hearing amplifiers to improve communication with our geriatric patients.

Evaluation:
There was a significant decrease in length of stay. There was a significant decrease in hospital costs of patients coded with delirium. There was a significant increase in the number of patients with delirium that were able to return home rather than placement in a SNF.

Implications for Practice:
There is a need to develop a risk stratification to identify those at risk for delirium, and early prevention. The patient and family should be involved in a prevention protocol. Having all healthcare staff learn to recognize the importance of early detection of delirium increases patient safety.