Improving Hospital Delirium Screening and Documentation.

Area of Science:

• Quality Improvement
• Patient Safety
• Healthcare Management

Background:

• Delirium screening is crucial for hospitalized patients, impacting outcomes and safety.
• Mayo Clinic identified low adherence (25.9%) to delirium screening and documentation protocols.
• Addressing these gaps is essential for improving care standards.

Purpose of the Study:

• Identify gaps and causes for low delirium screening adherence.
• Design and implement interventions to improve screening documentation rates by at least 50%.
• Ensure interventions do not negatively affect other nursing assessments.

Main Methods:

• A multidisciplinary team used Six Sigma methodology for a quality improvement project (May 2022-April 2023).
• Interventions included EHR restructuring of Brief Confusion Assessment Method (bCAM), nurse education, and a best-practice advisory (BPA).
• Delirium screening was integrated into shift documentation reminders; pressure injury risk assessment served as a counterbalance measure.

Main Results:

• Delirium screening documentation increased significantly from 25.9% to 47.7% after integration into shift reminders (P < 0.001).
• The BPA correlated with a 47% increase in clinician capture of delirium diagnoses in the EHR.
• Pressure injury risk assessment rates remained stable, indicating no adverse impact on other assessments.

Conclusions:

• Integrating delirium screening into shift documentation substantially increased adherence, exceeding the 50% target.
• The best-practice advisory improved clinician identification and documentation of delirium diagnoses.
• These interventions show potential for enhancing patient outcomes and safety through improved delirium management.