Medical floor confusion assessment method: Implementation and assessment of risk factors

Abstract

<p>An estimated 50% of older hospitalized patients experience delirium. This has created significant complications costing an estimated $164 billion or more per year worldwide. The ability to identify patients developing delirium would allow the implementation of specific interventions to decrease or eliminate the adverse effects of delirium. The purpose of this quality improvement project was to provide high quality delirium education to determine if medical unit nursing staff could successful implement the Confusion Assessment Method (CAM) screening tool to identify patients experiencing delirium as the first phase of an overall plan. Implementation of the project followed<br />Roger&rsquo;s diffusion of innovations theory. Patients were additionally screened for 5 potential risk factors of delirium from the multifactorial model of delirium to determine if delirium could be identified in the local population admitted to a single hospital. With a high quality education intervention, the staff nurses on the medical unit successfully implemented the CAM into their nursing practice and accurately identified delirium. Nurses identified delirium and subsyndromal delirium in 25% of the 208 patients in the study population. Consistent with the literature, patients who had a urinary catheter and experienced an iatrogenic event were predictors of delirium. An additional predictor of delirium, not included in the multifactorial model of delirium, included patients receiving<br />benzodiazepines. This quality improvement project suggests that quality delirium education combined with the use of an accurate delirium detection tool could predict delirium accurately in the medical floor population. This has the potential to reduce the impact of delirium on patients, hospital staff, and reduce hospital expenditures.</p>