• 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.