Delirium Screening and Prevention in Older Adult Post-Acute Care Patients

Purpose: The purpose of this quality improvement (QI) project was to create, implement, and evaluate an evidence-based delirium prevention protocol in a post-acute care facility in Sonoma County, California.Background: Delirium is a neurocognitive syndrome common in the older adult (65 years or older) population characterized by rapid onset, fluctuating attention, and disorganized thinking. Delirium is costly, under-recognized, and can be fatal. Delirium can lead to numerous short- and long-term complications, including long-term cognitive decline, functional decline, increased risk for 30-day readmission, and institutionalization. Despite these factors, delirium is preventable in up to 40% of older adult post-acute care patients. Method: This QI project followed the Plan-Do-Study-Act (PDSA) model. Skilled nursing facility staff were given in-service training specific to delirium risk factors and prevention. A delirium prevention protocol was then implemented for all new admissions. Pre- and post-implementation chart audits were conducted to assess new-onset delirium incidence in the older adult post-acute care population. Additionally, the staff was surveyed after implementation to evaluate their perception of the protocol. Results: In the pre-implementation chart audit sample, 8% of patients were diagnosed with new-onset delirium during their post-acute care stay. The post-implementation sample group had 0 cases of new-onset delirium. The licensed nurses found the protocol simple to use. This group also reported the protocol to moderately change their daily practice. The CNAs reported the education and protocol significantly changed their daily practice. Conclusion: This QI project’s results suggest that the implementation of a delirium prevention protocol can positively change nurse and CNA daily practice and has the potential to decrease the incidence of new-onset delirium