Rate of delirium onset during hospitalization

0 Comments

Delirium affects patient safety, patient experience, alternate level of care (ALC) rates, access, and flow. Delirium is associated with increased mortality in several care settings (emergency department, hospital care, and long-term care (LTC)) and prolonged length of stay in hospital (~8 days) (McCusker et al, 2003). Patients that develop delirium are 2.4 times more likely to be placed in LTC, which leads to longer wait times and a greater number of ALC days. Delirium is only recognized in about one-third of cases, so education and prevention strategies are critical to improving patient outcomes.

Key Resources

Delirium Quality Standard

Provincial Geriatrics Leadership Ontario Quality Standard Implementation Guide

Delirium Senior Friendly Hospital Toolkit

sfCare E-Learning Series

Change Ideas

Exercise caution when prescribing certain medications (e.g., sedative-hypnotics, benzodiazepines, opioids)

Reduce or eliminate prescribing listed medications that are known to increase risk of hospital- acquired delirium (when appropriate)
Process measure:Total benzodiazepines and other sedative-hypnotics (BSH) prescribed among BSH-naïve patients per 1,000 inpatient days – prescribing patterns may be available to GeMQIN hospitals via their MyPractice and OurPractice reports. Please contact GeMQIN@ontariohealth.ca for more information
Process measure: Percentage of BSH-naïve patients who are prescribed an in-hospital BSH
Process measure: Percentage of patients prescribed listed medications during their inpatient stay
GeriMedRisk
Choosing Wisely webinar on reducing prescribing of sedative-hypnotics
Choosing Wisely Canada: Drowsy Feeling Lousy Toolkit

Create a sleep-friendly environment

Create a sleep-friendly environment (e.g., staff education to offer culturally sensitive amenities to promote better sleep, reduce noise and lights, and engage patients and caregivers on education about sleep-friendly environment)
Process measure: Percentage of patients who were issued a survey about the quality of their sleep
Process measure: Percentage of patients who rate their sleep quality as good or better
Provincial Geriatrics Leadership Ontario Quality Standard Implementation Guide
Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Resources for Older Adults and Caregivers | Regional Geriatric Program of Toronto (rgptoronto.ca)
Caregiving Strategies Course & Handbook | Regional Geriatric Program of Toronto (rgptoronto.ca)
Adjust nursing workflow and reschedule non-essential medications during sleep hours  (for example, 22:00-0600)
Process measure: Percentage of patients who are administered non-essential medication during sleep hours.
Process measure: Percentage of patients whose nightly care routine is completed before sleep hours.

Engaging environmental services to reduce overnight noise and lighting
The Impact of Environmental Risk Factors on Delirium and Benefits of Noise and Light Modifications: A Scoping Review

Address delirium prevention and management strategies in daily huddles

Incorporate discussions on delirium prevention, sleep, and use of sedatives into daily huddles
Process measure: Percentage of patients discussed for risk factors of delirium in huddle
Process measure: Percentage of patients whose post-admission delirium onset date is recorded
Process measure: Percentage of health care professionals who have received education and training in screening for delirium and using standardized, validated tools.
Process measure: Percentage of people at risk for delirium who have interventions to prevent delirium documented in their care plan.
Importance of Huddles from the IHI
A Collaborative Approach to the Prevention and Management of Delirium: Webinar with Trillium Health Partners and RGP
PSW Pocket Guide for Delirium Identification
RGP -New Kid on the Delirium Screening Block
Delirium Triage Screening tool for Emergency Department
Alberta Health Services Confusion Assessment Method (CAM) Tool