Assessment, Management And Prevention of Delirium

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Assessment, Management And Prevention of Delirium

A MAP of Delirium A quality assurance project
translating evidence into clinical practice
Nicholas Waldron Chris Beer Mark
Donaldson Noellene Foster Royal Perth Hospital
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Introduction

• Delirium is common and important but
  under-recognised
• Recently developed Australian Best Practice
  guidelines
• Practice Evidence Gaps identified
• Local Challenges

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Aims

• Improve care for elderly patients on a busy acute
  general medical ward, focusing on Delirium
• Develop and implement locally appropriate tools
• No ongoing resources

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Method

• Engage Stakeholders and form steering committee
• Draft and pilot tools
• Baseline Data Collection
• Education and resources
• Evaluation

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Baseline - CAM day

• Prevalence 33 (10/30)
• 50 identified by medical staff
• Nurses noted confusion in all cases
• High risk population
• 29/30 had 3/6 risk factors
• Younger patients had high rates of delirium 4/7
• 50 recognised

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Baseline - Staff perception survey

• Response rate 55 (Dr 42)
• Knowledge deficits - pharmacology, recognition,
  risk assessment
• Satisfaction - overall vs current process,
  resources, value placed on staff
• Request to modify environment and provide
  resources and education

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Baseline Focus group

• Active involvement
• Approval of proposed tools
• Specifics for education need
• Staff felt under resourced and poorly supported
  to manage delirium

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Clinical Pathway
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Resource development

• Delirium guidelines
• Clinical care pathway
• Modified nursing care plan
• Pharmacology guidelines
• Delirium box with practical resources to aid
  nursing best practice
• Carer pamphlet
• http//line-ten.net/waldron/delirium.htm

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Follow up - CAM day

• Delirium rate 20 (6/30)

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Follow up - Staff perception survey

• Response rate 25
• Core knowledge improved
• Improved satisfaction
• Tools utilised

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Follow up Focus group

• Tools utilised and received well
• Support for delirium box, but refine
• Nursing care plan well received
• Demonstrating ownership
• Requesting pharmacology guidelines for younger
  population
• Consultants need education

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Conclusion

• A delirium care pathway was successfully
  implemented in a general medical setting, being
  well utilised and received.
• A process of active engagement allowed for
• ward ownership
• tailored local care pathways and guidelines
• tailored education program
• The project requires further refining before
  widespread hospital dissemination