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A Valuable Partnership ABIA and Summa

Michelle Kern, RN, Director, Inpatient Nursing, Crystal Clinic Orthopaedic Center, Orthopaedic Focus Winter 2010

As a healthcare professional, being presented with a patient who can be described as “out of it,” “not him- or herself” or “just not right” is nothing out of the ordinary. Though such symptoms or observations are commonplace, patients who experience such are most often suffering from a complex medical syndrome characterized by acute disruption of attention and cognition.

Formally known as delirium syndrome, this condition can result in a number of detrimental effects, including increased healthcare cost, lengthened time of stay, short- and long-term morbidity and even mortality.

The rate of occurrence among older, post-operative patients is a staggering 15 to 53 percent, resulting in this condition being seen in the everyday orthopaedic inpatient population.

Unfortunately, more often than not, it goes unrecognized. When properly diagnosed, it is rarely treated in the appropriate manner.

The goal of the clinical team at Crystal Clinic Orthopaedic Center is to improve awareness and recognition of delirium syndrome and increase its prevention in at-risk patients.

Additionally, considerable effort is put in to improving overall quality, patient safety, patient and family satisfaction and decreasing the average length of stay for patients.

Effective management of delirium requires all those involved in patient care to be appropriately educated in the differences between delirium and dementia, how to prevent it and appropriate treatment once delirium is diagnosed.

Educational sessions for resident physicians include common medications that increase the risk of delirium in elderly patients as well as alternatives and dosaging.

Delirium identification and management was given careful consideration during the building of current electronic clinical documentation. Major components included were:

  • The six item screener (SIS) score – completed with all patients whether in pre-admission testing, same-day surgery or admitted directly or via the emergency department to the inpatient nursing unit – screens and targets those most at risk.
  • Preventative protocols (plan of care) for those most at risk.
  • Surveillance tool/nursing delirium scale (NuDesc) is completed during each shift as part of ongoing assessment.
  • A delirium order set is available for those diagnosed with delirium syndrome.

Family education is equally important in the identification and treatment process. Keeping in mind that early intervention is crucial for a positive outcome, brochures are available to patients’ families to help them understand how they can help their loved ones avoid confusion while hospitalized following surgery.

Many thanks to the Department of Geriatric Medicine at Summa Health System for its support and educational efforts in helping the Crystal Clinic Orthopaedic Center meet the needs of its patient population.