Patient Safety Begins at the Time of Admission: The Impact of Delirium and Early Assessment

Belton-Flemming, Diane

The purpose of this project is to examine the relationship of early assessment and incidence of delirium among hospitalized patient‟s 65 years and older. This project was conducted using 376 patients, both male and female, on a 32 bed medical unit with cardiac focused care in mind. The CAM-ICU assessment tool was used as a guide to measure risk and predisposing factors for this particular group. Of those assessed the prevalence of health problems during this project were congestive heart failure/atrial fibrillation (20 %), pneumonia/ COPD (50 %) and urinary tract infections (30%). To increase awareness of delirium among nurses, methods of teaching included an educational poster for the unit, Power Point and video on how to use the adapted CAM-ICU tool. Nursing interventions included assessing for cognition/socialization, activity, toileting, oxygenation, sleep/rest, nutrition and pain. Alterations in any of these areas correlated with a higher incidence with delirium. Also, a review of medical charts, lab/test results and medications were performed. Nursing interventions to maintain patient safety were put into place for those at risk according to the CAM-ICU tool. Family participation was also encouraged at the bedside to decrease incidences of confusion, stimulate increase activity and recovery among patients.

Family members were also encouraged to provide information that patient sometimes could not remember or was not aware of. The results indicated that among the 376 patients assessed in this project 312 had predisposing factors; 64 had risk factors and 76 patients scored positive for CAM. In addition, the results suggest that early assessment is the catalyst for safe patient care therefore; more research and educational programs are needed to increase awareness of delirium.