Improving Nurses' Detection of Delirium in Hospitalized, Oncology Patients
Confusion Assessment Method (CAM) (CAM non-ICU)
adults and older adults
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
Background: Hospital-acquired delirium is an acute neurocognitive condition that occurs in nearly 60% of hospitalized older adults, increasing risk for falls, pressure ulcers and long-term cognitive impairments. While early detection and treatment help prevent these outcomes, many nurses report inadequacies when performing delirium assessments. This project's purpose was to design, implement, and evaluate an educational session about delirium and the evidenced-based confusion assessment method (CAM) for nurses on a large adult in-patient oncology unit. Methods: The 30-minute PowerPoint-facilitated session was presented in person nine times on the unit during September 2019. Nursing leadership (CAM Champions) promoted the session and role-modeled CAM use. Nurses' knowledge about delirium and the CAM was measured immediately pre- and post-session using a web-based 10-item questionnaire. Nurses' opinions about CAM assessments and the education session were collected anonymously via the questionnaires. To determine if the session increased CAM use and provider-initiated order sets for patients positive for delirium, charts from October 2018 and October 2019 were reviewed. T-tests and Pearson Chi-square were used to analyze the continuous and nominal data, respectively. Results: Sixty-seven of the 79 nurses on the unit (85.0%) attended the session and completed the questionnaires. The average age of the group was 31.0 (SD=8.0) years and the majority (59.4%) had more than two years of RN experience on the unit. The group's average post-session score (79.9%) was significantly higher than pre-session (68.8%) (p<0.0001, d=0.79). Most of the nurses (64.5%) conveyed their knowledge deficits about delirium and the CAM in the pre-session questionnaire. However, in the post-session questionnaire, the majority (98.3%) reported that the educational session effectively addressed those deficits. The average percent of times the CAM was used post-session (45.5%) was significantly higher than pre-session (29.5%) (p<0.0001, d=0.54). The percentage of patients positive for delirium post-session (11.5%) was higher than pre-session (7.3%) (p=0.13), and the percentage of patients never assessed for delirium post-session (8.5%) was significantly lower than pre-session (23.9%) (p=0.0009). There was minimal change in the number of provider-initiated order sets for a delirium diagnosis post-session (2) versus pre-session (0). Conclusion: While a nurse-targeted educational session significantly improved nurses' knowledge about delirium and increased their use of the CAM in a high-risk population, the number of provider-initiated order sets for delirious patients did not increase as expected. Leadership support, annual education for all healthcare providers, and facilitated communication between staff nurses and advanced care providers are needed to improve delirium assessment accuracy and treatment.
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