Implementation of a Delirium Assessment Tool

Abstract

Problem: Delirium in hospitalized older adult patients is associated with significant adverse outcomes such as re-hospitalization, extended length of stay, functional decline, and increased morbidity and mortality rates. In non-intensive care unit (ICU) patients, the incidence of delirium is estimated to affect between 10% to 50%. Purpose: The purpose of this Quality Improvement (QI) project is to provide bedside nurses education on delirium and implement a bedside delirium assessment tool to assist in early identification. Providing care that is proactive and focused on prevention, as opposed to reactive and focused on treating identified conditions, is known to have better patient outcomes. Methods: A 24-bed medical surgical unit was selected to participate in the delirium assessment intervention. Patients aged 65 years and older and not on hospice or palliative care were the target intervention population. To achieve the project objective, staff reviewed an education module focusing on delirium and the selected bedside tool called the 4AT Rapid Clinical Test for Delirium. After participating in a pre-learning module with a pre- post-test, nurses then began completing the assessment tool on the designated population once per shift. When a completed assessment reflected possible delirium, the assigned provider was notified. Results: Upon completion of the education module the post-education survey reflected an increase in knowledge by 9.15%. The assessment tool had an implementation rate of 62.35% on day shift and 10.57% on night shift. Out of 552 completed assessments, eighty-three identified possible delirium (15.04%). Conclusions: The QI project demonstrated the effectiveness of providing delirium education to bedside nurses and the successful implementation of a brief assessment tool to identify patients at a risk for delirium.