Identifying Delirium in the Geriatric Population

Abstract

Delirium is a severe change in brain function that can have short and long-term consequences for the hospitalized geriatric patient. Untreated delirium can lead to increased lengths of stay, falls, reduced function post-discharge, and even increased mortality. Delirium screening with a validated tool is the first step in the early detection and treatment of delirium for the geriatric population. The purpose of this projectis to implement a standardized delirium screening tool for all patients age sixty-five and over ona family medicine unit at a large teaching hospital. This project pilot included educating staff nurses on a medicine unit to use the brief Confusion Assessment Method (bCAM) screening tool to identify geriatric patients with signs of delirium. The goal was 90% nursing compliance in using the bCAM screen daily for all patients 65 years of age and older. Over twelve weeks, 912 of the 1,431 patients sixty-five years of age or older identified as eligible for screening received a complete delirium screen. Eight geriatric patients had a positive screen without a previous diagnosis of delirium on the hospital problem list. Several limitations and barriers were identified and addressed during the biweekly PDSA evaluations. Findings from this project paired with nursing feedback laid a foundation for a delirium education rollout organization-wide, standardized delirium screening for patients sixty-five years and older, and the development of a nurse-driven protocol to treat patients with a positive screen.