SHM Converge Scientific Abstract ePoster Gallery-Introducing Delirium Protocol

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This quality improvement project aimed to reduce delirium in hospitalized patients at a 1,000-bed safety net hospital. The pilot was conducted on a 34-bed Acute Care Unit from January 10 to March 6, 2024, targeting patients with delirium or at risk for delirium, such as older adults, those with neurocognitive disorders, prior stroke, sensory impairment, psychosis, long ICU stays, or immunocompromised states.<br /><br />The intervention was a multidisciplinary delirium prevention protocol that included an order set, a patient-room poster, and a nursing checklist. The order set used RASS screening and promoted sleep hygiene, reorientation, and mobilization. Nursing compliance was measured anonymously through paper checklists, scored as all-or-none and partial completion. Outcomes were tracked through chart review, focusing on the proportion of patients with active delirium and length of stay (LOS). Nurses were also surveyed about workload impact.<br /><br />Results showed strong protocol adherence: 652 checklists were reviewed, and nursing staff completed 83% of checklist items. A total of 180 patients were placed on delirium precautions, averaging 18 patients per day. About 3 new candidates were identified daily. After implementation, there was a non-random decline in active delirium cases, including 6 days with no active delirium. Average LOS decreased from 12.14 to 10.83 days overall in patients at risk for or with active delirium. In patients at risk alone, average LOS dropped from 11.26 to 9.79 days, and median LOS decreased from 7 to 6 days. Most nurses (89%) reported that the protocol did not increase workload or made it easier.<br /><br />Overall, the protocol appeared feasible, well-adopted, and associated with improved delirium outcomes and shorter hospital stays.

Asset Subtitle

Ankur Segon

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Author List Alissa Cooney, Ankur Segon, Desirae L. Garcia, Farhana F. Khaja, George O. Odhiambo, Griselda Camacho, Juan Garza, Michel Tabet, Nadia Wakil, Nelson Tuazon, Wayne G. Fischer

Category Innovations

Concept Delirium Prevention Protocol

Concept Delirium Precautions

Concept Delirium Risk Factor

Concept Active Delirium Rate

Concept Length of Stay

Distinguished Non-Finalist

Presenter Organization The University of Texas Health Science Center at San Antonio Joe R. & Teresa Lozano Long School of Medicine

Presenting Author Ankur Segon

Track Quality Improvement

Keywords

delirium prevention

hospitalized patients

quality improvement

multidisciplinary protocol

acute care unit

nursing checklist

sleep hygiene

length of stay

RASS screening

safety net hospital

Delirium Prevention Protocol

Delirium Precautions

Delirium Risk Factor

Active Delirium Rate

Length of Stay