Hospital Wide Delirium Prevention ,Detection and Treatment Leveraging Capabilities of the Electronic Medical Record

Purpose:
Large regional hospitals serving a high percentage of geriatric patients cannot let size be the barrier to applying evidence-based practices for delirium to all high-risk elders. Success in small geriatric units,does not always translate to non-specialized units. This challenge defines this project.

Significance:
This model uses current workflow to offer the opportunity to disseminate the practice of screening, preventing and treating delirium effectively to all adult units. An inclusive model benefits the at-risk adult patient regardless of unit assignment, thus increasing safety and reducing harm.

Strategy and Implementation:
Build the culture that delirium is preventable, recognizable and reversible. Quality improvement, without regard to work processes, is ineffective. Often more work is added and nothing is removed. This design incorporates addressing delirium in the current electronic medical record workflow. At shift assessment, safety risk screenings are completed; appropriate innovations follow directly below the screening. Full documentation is in one place; intervention documentation flows into the care plan. Delirium tools were created to fit this process. All adult units received delirium education using online modules. Education within unit walls is achieved with posters and monthly newsletters targeting issues, or new information. A team of unit champions supports the initiative at the peer level; tracking data and supporting staff. Physician education is also targeted. Incident delirium and practice compliance, are electronically audited; results are posted and reviewed monthly on units.

Evaluation:
Success is reduction of hospital-acquired delirium by 50 percent from the measured baseline. Incidence is the first positive delirium score more than 24 hours post-admission. Audit measures for all interventions to be done within a 24-hour period,for full stay. Data collection continues to 09/30/12.

Implications for Practice:
Adaptation of an existing electronic record and honoring current workflow allows best practices to be supported on a larger scale than previously thought possible. Improved outcomes are possible for a greater portion of at-risk elders, admitted to non-geriatric units.