Delirium: A CNL-Led Protocol to Clear Up the Confusion

Project objectives: Delirium is a form of organ failure defined as an acute change in cognition, evidenced by altered consciousness and impaired attention that fluctuates over time, and is associated with increased morbidity, mortality, and healthcare services utilization. In the hospital where this evidence-based practice project took place, there was no formal protocol or guideline for assessing or managing delirium. Therefore, this project focused on improving the practice of identifying patients at risk for developing delirium with the AWOL tool and treating patients with signs and symptoms of delirium found using the Short-CAM assessment. Population and setting: This project took place on a Neuro-Telemetry unit where the average patient age was 50 and above and the main diagnosis seen was some type of cerebral vascular accident. Methods: Using Lewin’s change theory, the CNL-student met with unit staff in small groups and one-on-one to initiate the project and then implemented the change and collected the data by working with staff at the bedside through coaching and role-modeling. Data: Of the ninety-eight patients assessed using the AWOL tool, fifty patients scored as moderate to high risk for developing delirium and four of these fifty patients developed signs and symptoms of delirium as evidenced by the Short-CAM assessment. Two of these four patients received a diagnosis of delirium by the physician and three of these four patients had an extended length of stay. Conclusion: Delirium is one of the most frequent, costly, and disabling conditions experienced by older adults in the acute care setting. This project relates to the CNL competencies in that it facilitates practice change based on the best available evidence in quality, safety, and fiscally responsible outcomes. In order to meet the growing call of the CNL as a guardian of safe patient care, and for policies and protocols for delirium in the acute care setting, the future stages of this project will focus on policy development and lateral integration of EBP delirium care