Preventing Delirium in Geriatric Hip Fracture Patients with a Bundled Approach

Abstract

Background: On a 29-bed surgical unit specializing in orthopedics, neurosurgery, and head and neck surgery in a community hospital, the rate of delirium in geriatric hip fracture patients is over 34%. Patients who developed delirium had a 3.1 day longer average LOS and 14.2% higher need for sub-acute rehabilitation on discharge. Objective: The objective of this project is to decrease the rate of delirium in geriatric hip fracture patients on the unit by implementing a delirium prevention bundle whose components were care planning, early mobility, and sleep hygiene. Methods: Nurses on the project unit were formally trained in the use of CAM and bundle components. Documentation within the electronic health record was expected for all included patients. Data on bundle component completion, LOS and discharge disposition were collected on a weekly basis. Results: 100% of nurses were trained on the delirium prevention bundle and CAM assessment. The rate of delirium during implementation was 15.6%. CAM was documented correctly 93.8% of the time. Overall average LOS was 4.4 days (with delirium 5.4 days, n=5; without delirium 4.2 days, n=27). The rate of discharge to subacute rehab was 81.3%. Accurate completion of individual bundle components shows 95.3% care-plan documentation, 90.6% implementation of sleep hygiene interventions, and 84.4% initiation of early mobility. Conclusions: These findings suggest that formal education on CAM has increased nursing recognition of acute onset delirium. They also suggest that the use of a multicomponent bundle is effective in reducing the overall rate of delirium, however, there was limited impact on LOS or discharge disposition. Practice implications were that a bundled approach with CAM training worked to decrease delirium, but several other factors influenced LOS and discharge disposition.