Early identification and delirium recognition in acute care: A quality improvement initiative

Abstract

Recognition of delirium continues to be a challenge in acute care despite the use of validated and reliable tools. This evidence-based quality improvement project aimed to increase delirium recognition by increasing daily screening using the Confusion Assessment Method (CAM) tool. Methods to increase usage and accuracy of the assessment included targeted education by specially trained geriatric nurse champions (GNCs). During rounds, GNCs performed bedside assessment, provided real-time feedback, and focused on non-pharmacological interventions on medical-surgical and telemetry units. All patients 65 years of age and older were included. Daily screening of CAM assessment increased by 7.6 % over three months, including an increase in CAM positive results from 7.1 % to 8.5 %-additional favorable outcomes observed with an increase in delirium diagnosis. This project increased knowledge retention and reinforcement of non-pharmacological interventions through peer coaching and focused rounds. Continued training efforts and education are needed to increase identification of patients experiencing delirium.

Keywords: Confusion assessment method (CAM); Delirium; Early identification; Geriatric clinical nurse specialist (GCNS); Geriatric nurse champions (GNCS); quality improvement (QI).