Delirium protocol essential, feasible in hospitalized non-ICU patients

Development and implementation of a delirium protocol for patients who were not in the ICU was attainable, according to research presented at the Society of Hospital Medicine Annual Meeting.

"Delirium affects 20% to 60% of the general hospitalized patients, and up to 85% of [ICU] patients," the researchers reported in their abstract. "Its occurrence is associated with higher morbidity and mortality, long-term institutionalization, worse long-term cognitive outcomes and increased hospital length of stay and costs. It is often missed due to lack of standardization in assessment and diagnostic methods and lack of awareness among physicians and other health care providers."

Nidhi Rohatgi, MD , of Stanford University School of Medicine, and colleagues noted that there was no standardized approach for delirium prevention or management in non-ICU patients at their institution.

They created a multidisciplinary group that included hospitalists, psychiatrists, neurologists, nurses and physiatrists to review current practice and literature to develop the delirium protocol.

Rohatgi and colleagues implemented the protocols via their electronic medical record system in June 2015.

Their prevention protocol consisted of:

nurses screening all inpatients for delirium risk daily;
nurses initiating nonpharmacological treatments for high-risk patients, including early mobility, pain control and caregiver education;
nurses screening all inpatients each shift for delirium using the confusion assessment method (CAM); and
physicians order set for delirium screening and prescribing sleep aids if needed.

Their management protocol consisted of:

nurses initiating nonpharmacological treatments;
nurses paging team of physicians to imitate delirium order set;
physicians initiating order set to determine delirium cause and issue medications as needed; and
nurses monitoring patients with CAM for delirium resolution or re-emergence.

"A systemic and collaborative approach is essential to prevent and manage delirium," Rohatgi and colleagues concluded. "With this initiative, we created and implemented a MD-RN protocol feasible for use among hospitalized non-ICU patients."

They stated that additional studies will assess the protocol's effect on patient outcomes. – by Chelsea Frajerman Pardes

Reference:

Rohatgi N, et al. Abstract 260. Presented at: Society for Hospital Medicine Annual Meeting; March 6-9, 2016; San Diego.

Disclosure: Healio Internal Medicine could not confirm relevant financial disclosures at the time of publication.