Targeted Education to Improve Delirium Screening Among Neuroscience Patients

Abstract
Delirium is a significant clinical concern that results in longer hospital and intensive care unit lengths of stay; increased morbidity, mortality, and healthcare costs; and is associated with long-term cognitive deficits and neuropsychological disorders. Considering healthcare system burdens and poor patient outcomes related to delirium, there has been emphasis on early recognition of patients experiencing delirium. The literature supports the importance of screening for delirium at the bedside and identifies tools used to meet this end. However, most studies exclude use of the tools in neuroscience settings because of the complexity assessing delirium in neuro-compromised patients.
The Confusion Assessment Method for the intensive care unit (CAM-ICU) is a validated screening tool for delirium in neuroscience patients, yet there is still a gap in the literature regarding application of the CAM-ICU for neuroscience patients. The purpose of this project was to increase neuroscience nurses’ ability to accurately document delirium assessments using the CAM-ICU by minimizing the use of “unable to assess” and increase detection of delirious patients in a neuroscience intensive care unit. A pre- and post-test design was used to evaluate changes in mean baseline documentation accuracy rates. Audits of electronic health records (EHRs) were conducted pre- and post-educational intervention to determine unit level documentation accuracy rates. A formal 30-minute educational presentation was offered to eligible registered nurses (RNs) in the neuroscience intensive care unit, with subsequent coaching sessions for those who attended the presentation. There were 124 documentation audits retained in the pre- and in the post-education intervention phase of the study. The mean pre-audit documentation accuracy rate increased from .44 to .83 (p < .001). The results provide further evidence that formal education for RNs on use of the CAM-ICU instrument improves documentation accuracy and delirium identification in this highly at-risk patient population. Future research should focus on the impact formal education has on each of the outcome possibilities of the CAM-ICU and the collaborative development of treatment protocols.
Keywords: CAM-ICU, RASS, delirium, delirium screening, neuroscience, baseline mental status, quality improvement