Championing Interdisciplinary Delirium Recognition, Prevention, and Treatment for Hospitalized Adults

Purpose:
In 2010 UVA implemented delirium screening for critical and adult acute care in-patients. The hospital steward for delirium utilized chart audits to determine screening compliance. In 2011, a unit-based champion model was begun. A taskforce pursued education, resources, and treatment guidelines.

Significance:
The problem of delirium for hospitalized adults is well published and publicized. Increased mortality, LOS, and other complications such as falls or self-discontinuation of needed therapies are sequelae of delirium. Appropriate screening for delirium is a patient safety strategy.

Strategy and Implementation:
Delirium screening utilizing the CAM-ICU for critical care and a modified CAM for acute care was in place. The educational efforts for implementation for critical care were robust due to the higher prevalence in ICU; compliance with delirium screening in acute care was adversely affected. The decision was made to utilize best practice champions to provide unit-based resources and education. Ploeg, et.al (2010) described best practice champions as change agents to provide awareness and lead in interdisciplinary teams. The interdisciplinary group included RN champions, physicians, and pharmacists led by a CNS. Activities of the group included extensive education of the RN champions by the CNS, survey of bedside RN knowledge regarding delirium, compilation of non-pharmacologic interventions, collaborative efforts of physicians and pharmacists to develop pharmacologic guidelines, and approval of delirium recognition, prevention, and treatment guidelines for acute and critical care.

Evaluation:
The champion model has increased engagement in delirium recognition and management. RN champions report success providing education and incorporating screening demonstrations into skills fairs. Physician partners collaborated to include delirium into the LIP practice newsletter and grand rounds.

Implications for Practice:
Compliance with delirium screening twice daily improved to 99.5%. The CNS-led group successfully improved EMR documentation and had a delirium risk banner to be triggered based delirium screening. Improving accuracy of screening and increased use of non-pharmacologic interventions are 2013 goals.