Increasing Utilization of the Delirium Prevention Protocol in Post Cardiovascular Surgery to Improve Quality and Safety of Healthcare

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Background and Objectives: Post-operative delirium (POD) is the most common complication seen following surgery in older adults. Two-thirds of delirium cases are diagnosed late or missed in everyday practice across health care settings which can lead to a variety of long-term complications. POD prevalence can be reduced within inpatient practice settings by utilizing established screening tools, such as the Confusion Assessment Method (CAM). This project aimed to increase nurse screening of delirium and provide education on POD to nursing staff on the post-cardiovascular surgery unit to increase utilization of the delirium prevention protocol.

Methods: Educational sessions provided to nursing staff included delirium risk factors, signs and symptoms, complications, and the introduction of interventions from the delirium prevention protocol. Data was collected by the CNL student weekly over a 4-month period including chart audit to determine the utilization of the CAM tool, protocol, and visual cues learned from education sessions. Interventions were adjusted based on the PDSA cycle.

Results: Thirty-eight of 89 nursing staff received educational sessions. Retrospective chart review identified 0% of delirium screenings were completed by the registered nurses and the delirium prevention protocol was initiated by the provider on admission. The CNL student adjusted implementation efforts to role-model delirium screening and in addition provide education to patients determined high risk with two or more risk factors for delirium. Eleven of 47 patients eligible for the delirium prevention protocol received a consult. There was an increase in the utilization of the delirium prevention protocol from 0% to 23.4%.

Discussion: While educational sessions can increase utilization of the delirium prevention protocol, the role of a CNL can greatly improve patient outcomes related to delirium. Role-modeling behavior can also translate to improving staff utilization of the delirium prevention protocol on the cardiovascular surgery unit.

Keywords: delirium, older adults, cardiovascular surgery, quality improvement, prevention, CAM tool

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