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Preoperative cognition screening and postoperative delirium in older surgical patients
(2016-12-21)
People 65 years or older are having surgery later in life and are at risk of developing a major postoperative complication, delirium. The Montreal Cognitive Assessment, is a preoperative cognitive screening tool which was used to screen thirty-three older orthopedic surgical patients to reduce the incidence of this serious postoperative complication. Patients who scored below normal were identified as at risk and monitored to ascertain if identification and monitoring influenced their postoperative course. At the first postoperative visit, each patient was evaluated for falls, confusion, and the ability to follow the required postoperative home exercise program to identify an undetected episode of delirium after discharge. Of the patients screened, 34.1% (n = 14) of patients fell below the cutoff for normal cognition. Subsequent monitoring and nursing interventions may have influenced their postoperative course as there were no reported episodes of delirium in the 90-day period. Thus, preoperative screening with the Montreal Cognitive Assessment tool provides a baseline cognitive assessment and early identification of patients at higher risk for postoperative delirium, and therefore, identification of patients at risk for postoperative delirium may allow for early interventions and decrease postoperative delirium....
Early detection and management of delirium through routine nurse screening on older adult hospitalized patients
(2016-10-20)
Nurses play a crucial role in implementing care designed to reduce delirium’s duration and severity. Unmanaged delirium in the older adult patient population can result in prolonged hospitalization, profound decline in health status, and possible short or long-term institutionalization. A nurse-driven delirium management protocol was piloted on an orthopedic surgical unit over a period of four weeks. The goal was to detect delirium early in the postoperative period for early management and thus, the patient would be free of delirium symptoms at discharge.
All patients age 65 years old and over were assessed for delirium every shift and a delirium nursing care plan was implemented on those identified as positive for delirium. A total of 81 patients were assessed for delirium with nine percent (9%, n=8) testing positive at some point during their hospitalization. Delirium nursing care plans were implemented on all these patients and none of these patients exhibited delirium symptoms at discharge. The nurses’ ability to recognize delirium using a standardized assessment tool can lead to early management and reduce delirium’s severity and duration....