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Prevention, detection and intervention with delirium in an acute care hospital: a feasibility study
Lynn Benedict1, Susan Hazelett, Eileen Fleming
1Clinical Nurse Specialist ACE Unit, Senior Services, Summa Health System, Akron, OH, USAResearch Associate, Summa Health System, Akron, OH, USANursing Research Coordinator, Summa Health System, Akron, OH, USAProfessor and Director of International Initiatives, College of Nursing, Kent State University, Kent OH, USACollege of Nursing, Kent State University, Kent, OH, USAClinical Lead Pharmacist-Geriatrics, Summa Health System, Akron, OH, USA and Assistant Professor of Pharmacy Practice, Northeastern Ohio College of Pharmacy, Rootstown, OH, USAGeriatrics Coordinator, Post-Acute Senior Services Line, Summa Health System, Akron, OH, USAVisiting Professor, College of Nursing, Kent State University, Kent OH, USAChief, Division of Geriatric Medicine, Summa Health System, Akron, OH, USACAQ Geriatrics and Medical Director, Physicians House Call Program, Division of Geriatric Medicine, Summa Health System, Akron, OH, USA.
Abstract:
Background. The prevalence of delirium in acute care hospitals ranges from 5-86%. Delirious patients are at greater risk of negative health outcomes and their care is often more costly. Aim. To determine the feasibility of a full-scale trial to test the effectiveness of an intervention designed to improve delirium prevention, detection and intervention in an acute care hospital. Design. A delirium prevention protocol was designed by an interdisciplinary group of clinicians and implemented on intervention unit patients who passed a mental status screen, were at high risk for delirium according to the modified NEECHAM scale, and met other eligibility criteria. These patients were reviewed at daily interdisciplinary team meetings and team recommendations were placed in the patient's chart. On the usual care unit, physicians were notified if their patients were at high risk, but the delirium protocol was not implemented. Methods. The delirium protocol was pilot tested with 35 high risk patients on an Acute Care for Elders (ACE) unit. Outcomes were compared to 35 high risk patients on a similar medical unit without the delirium protocol. Results. The main outcome examined whether there is a difference in average day 3 modified NEECHAM scores comparing the intervention and control groups. The mean modified NEECHAMs on day 3 were not statistically significantly different (intervention group 3.76 and control group 3.24) (P= 0.368). Baseline NEECHAM scores did not correlate well with development of delirium (P = 0.204). A history of confusion during a previous hospitalization was the strongest predictor of developing delirium during the current hospitalization. Conclusion. This pilot study was not powered to detect an effect of the intervention, however, feasibility for a fully powered trial was established. Relevance to clinical practice. Completion of the NEECHAM screen every shift was not considered burdensome for either nurses or patients and may help identify acute delirium.
