Delirium as a Medical Emergency: Leading the Community Into Action

Purpose:
This hospital wide Qi initiative designed to foster a practice change towards improving delirium recognition and treatment targeted all inpatient and outpatient clinical departments, multidisciplinary staff groups, administrators, patients, families, community physicians and the community at large.

Relevance/Significance:
Delirium is increasingly recognized as an acute correctable medical problem. It affects approximately one of five patients in the acute care setting, with nearly 2/3 of specific patient populations experiencing symptoms. Often under-recognized by clinicians, it can have long-term effect for patients and families if untreated. Results of a survey conducted across clinical areas in our community hospital revealed both knowledge and practice gaps related to delirium assessment and treatment.

Strategy and Implementation:
After forming a multidisciplinary committee, the strategic planning process included: 1) Assessing and defining delirium as a medical emergency 2) Formulating a patient centered plan for identifying and treating delirium 3) Disseminating evidence based practices and educational materials individualized for specific groups 4) Evaluating effectiveness of interventions using measured outcomes. Recognizing the key contributions of family members in the planning process, guidance from the Patient and Family Council (PFAC) was sought in the development of educational and “marketing” materials used for each audience. Materials included: a patient story, video, brochure, “Delirium Alert for patients and families,” “Preventive Techniques for Caregivers,” articles in the newsletter, use of the Beers Criteria for appropriate medication use, activity carts and evidence based protocols on poster presentations.

Evaluation:
The PFAC input led to fine-tuning educational materials and processes used by hospital staff, particularly toward dispelling myths about delirium, optimizing family involvement in identifying symptoms, and selecting interventions geared toward each patient's unique needs. Additionally, after 1 year of implementation trends show a decrease in Lorazapam and Haloperidol use for patients.

Implications for Practice:
Patients, families and health care practitioners across all practice settings need to be well equipped to prevent, recognize and manage of symptoms of delirium. Obtaining input from patients and family was key in this initiative to leading the community into action towards that goal.