• Implementation of a Delirium Prediction Score in Patients with Acute Stroke

      Haymore, Joseph B. (2016)
      Background: Delirium is common in patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICS) (10% - 48%) and associated with worse patient outcomes. Practicing clinicians have difficulty reliably detecting delirium in patients with AIS or ICH. The prevention of delirium is therefore a potentially beneficial strategy and is most effective in patients who are at high risk for delirium. This project implemented a validated delirium prediction score (DPS) into clinical practice for use with patients with AIS or ICH. Methods: During a 6-week implementation project, the Advanced Practice Providers (APPs) (Nurse Practitioners, n=9, and Physician Assistant, n=1) in a 10-bed Neurocritical Care Unit (NCCU) at a large urban quaternary care academic medical center used a previously validated DPS to risk-stratify consecutive admissions of patients with AIS or ICH into low (<5%), moderate (5%-20%), or high (>20%) risk categories for delirium. Compliance data were collected and analyzed with descriptive statistics. At the completion of the project, the APPs were asked to complete the System Usability Scale (SUS) and provide qualitative data to determine the usability of the DPS and assess for facilitators and barriers for the use of the DPS. Results: Patients admitted with AIS or ICH (n=20) were assessed by the APPs using the DPS (n=18/20, 90%). The score on the SUS (76.7) was mid-point between “acceptable” and “excellent.” Facilitators and barriers for use of the DPS were identified. Conclusions: The DPS was reliably used and was considered usable by the APPs. The DPS is a valid delirium risk assessment tool that can be used in patients with AIS or ICH. The adoption of the DPS with this patient population can be a first step in identifying the most at-risk patients for developing delirium and targeting these patients for delirium prevention strategies in this vulnerable population.
    • Postoperative Delirium Screening in Older Adult Surgical Patients

      Bastian, Salina M.; Yarbrough, Karen (2022-05)
      Problem & Purpose: Postoperative delirium occurs in up to 65% of older adult surgical patients and is associated with increased morbidity and mortality, increased length of hospital stay, and significantly increased healthcare costs. Perioperative leadership at a 275-bed advanced tertiary care hospital has stated considerable concern regarding the delirium noted in postoperative older adult patients. The purpose of this quality improvement project was to implement use of the Mini-Cog screening tool in a same-day surgery preoperative unit to identify outpatients aged 60 years and older that are at high risk for postoperative delirium and evaluate the compliance of screening. Methods: The Mini-Cog screening tool was implemented into the preoperative intake process of older adult surgical outpatients presenting to the same day surgery unit. The screening was conducted by anesthesia personnel to identify patients who possess a high risk of postoperative delirium and screening results were documented in a premade packet. Each patient’s respective postoperative delirium risk was used to create a tailored anesthetic plan with consideration of avoiding delirium-causing agents. Data collected, via chart audits of daily surgical case list and completed postoperative delirium packets, included compliance of Mini- Cog screening and the number of screened patients who were identified as high-risk for postoperative delirium. Univariant analysis, including percentages, were used to measure compliance to postoperative delirium screening. Results: Preoperative Mini-Cog screening compliance was 49.2% (60/125) and 18.3% (11/60) were identified as being high-risk for postoperative delirium. Conclusion: Preoperative implementation of the Mini-Cog screening tool to identify older adult surgical patients at high risk for POD is feasible and helps ensure the highest quality of care delivery. Adequate number and availability of screening personnel is paramount to screening the maximum number of eligible patients.