Stop. Think. Delirium! A quality improvement initiative to explore utilising a validated cognitive assessment tool in the acute inpatient medical setting to detect delirium and prompt early intervention

Angela Malik, Todd Harlan and Janice Cobb

Journal of Clinical Nursing, 2016, vol. 25, issue 21-22, 3400-3408

Abstract: Aims and objectives The paper examines the ability of nursing staff to detect delirium and apply early intervention to decrease adverse events associated with delirium. To characterise nursing practices associated with staff knowledge, delirium screening utilising the Modified Richmond Assessment Sedation Score (mRASS), and multicomponent interventions in an acute inpatient medical unit. Background Delirium incidence rates are up to 60% in frail elderly hospitalised patients. Under‐recognition and inconsistent management of delirium is an international problem. Falls, restraints, and increased hospital length of stay are linked to delirium. Design A descriptive study. Methods Exploration of relationships between cause and effect among cognitive screening, knowledge assessment and interventions. Results Success in identifying sufficient cases of delirium was not evident; however, multicomponent interventions were applied to patients with obvious symptoms. An increase in nursing knowledge was demonstrated after additional training. Delirium screening occurred in 49–61% of the target population monthly, with challenges in compliance and documentation of screening and interventions. Technological capabilities for trending mRASS results do not exist within the current computerised patient record system. Conclusions Delirium screening increases awareness of nursing staff, prompting more emphasis on early intervention in apparent symptoms. Technological support is needed to effectively document and visualise trends in screening results. The study imparts future research on the effects of cognitive screening on delirium prevention and reduction in adverse patient outcomes. Relevance to clinical practice Evidence‐based literature reveals negative patient outcomes associated with delirium. However, delirium is highly under‐recognised indicating future research is needed to address nursing awareness and recognition of delirium. Additional education and knowledge transformation from research to nursing practice are paramount in the application of innovative strategies. Focus is placed on nursing staff because nurses are at the bedside and are able to identify early signs of delirium.

Date: 2016
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