Date of Completion

Spring 5-10-2022

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Priscilla Gazarian

Site Advisor

Christine Smith

Abstract

Description of the Problem: Delirium is defined as a constellation of symptoms that includes disturbance in attention or awareness, change in cognition, language and perceptual disturbances that develops over a short period of time. Delirium mostly affects adult patients with risk factors including history of dementia, early cognitive impairment, dehydration, and infections. This quality improvement project was implemented on one hospital unit at a large tertiary hospital in the Boston area. This unit has one highest rate of delirium in the entire hospital system. Delirium is associated with high rate of morbidity and mortality. Also, this syndrome leads to longer hospital stays and high cost to both national and local budget.

Available Knowledge: A review of the literature revealed that a bundle of interventions including frequent re-orientation, adequate sleep, hydration, treating infections, and availability of sensory support were effective in decreasing the incidence and severity of delirium.

Specific Aims: The overarching aim of this quality improvement (QI) project was to identify at least 90% of patients at risk of delirium, implement the delirium bundle in at least 90% of the patients identified to be at risk by the nursing staff, and decrease the rate of delirium by at least 10%.

Interventions: Patients over the age of 65 years were identified by the Confusion Assessment Method. For the patient who screened at risk, the delirium bundle was implemented. The delirium prevention bundle including early mobilization, frequent reorientation, adequate hydration, adequate sleep, appropriately managing infections, and pain management.

Evaluation: The delirium bundle intervention was implemented comparing a 30 day preimplementation to a 30 day post-implementation period. The first aim of 90% identification of delirium was not me. The nursing staff identified 69% of patients at risk of delirium. The second goal of 90% implementation of the delirium bundle was met, with more than 100% implementation of the delirium bundle. The last goal of 10% decrease in the rate of delirium was met, with 15% decrease in the rate of delirium.

Results: This QI project was able to accomplish two out of the three aims. The aim that 90% of the patients was not achieved with 69% of at-risk patients identified. The project successfully implemented the bundle in over 100% of the patients that were identified. Lastly, the goal of greater than 10% decrease in the rate of delirium was achieved, with 70% decrease.

Conclusion: This QI project overwhelmingly achieved its target aim of more than 10% decrease in the rate of delirium. Thus, the interventions contained in the delirium bundle have conclusively shown that if used appropriately, they have the potential to dramatically decrease this chronic syndrome. Long term, these strategies have the potential to penetrate not only the intervention unit, but also all the other units in the clinical macrosystems and across other health care systems in the state.

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