Delirium Screening of Patients on a Neuroscience Step-Down Unit

Mulkey, Malissa A.
Olson, DaiWai M.
Misrahi, Sarah
Hardin, Sonya R.

Malissa A. Mulkey, PhD, APRN, CCNS, CCRN, CNRN, is Clinical Nurse Specialist, University of North Carolina-Rex Hospital, Raleigh, NC; and Post-Doctoral Research Fellow, Indiana University-Purdue University, Indianapolis, IN.
DaiWai M. Olson, PhD, RN, CCRN, FNCS, is Professor of Neurology, University of Texas Southwestern, Dallas, TX.
Sarah Misrahi, BSN, RN, SCRN, is Clinical Nurse, University of North Carolina-Rex Hospital, Raleigh, NC.
Sonya R. Hardin, PhD, CCRN, NP-C, FAAN, is Dean, School of Nursing, University of Louisville, Louisville, KY.

Acknowledgment: The authors thank Beverly Murphy, MLS, AHIP, FMLA, Medical Librarian for assistance with the literature review.

Note: This work was partially funded by an NRSA T32 (NR018407) Post-Doctoral Research Fellowship in Advanced Training in Self-Management Interventions for Serious Chronic Conditions grant.

MEDSURG Nursing 30(6):p 414-418, November-December 2021.

This project aimed to identify patients who had experienced a stroke and were at risk for delirium earlier, and implement evidence-based protocols to reduce overall length of stay and mortality. Nurses were motivated to perform screening and implement strategies that benefit patients who had experienced acute stroke. Results suggest early identification and treatment of delirium, use of prevention strategies, and treatment of the underlying etiology can improve patient outcomes and reduce cost of care.

Literature Summary

As many as 38% of acutely ill patients who experienced a stroke will develop delirium during hospitalization ().
Patients who have experienced a stroke are particularly vulnerable, and those who develop delirium are at higher risk of functional dependence on hospital discharge (^;).
Implementation of delirium prevention interventions significantly affected delirium incidence and severity, stroke impact, and length of hospitalization among older adults experiencing an acute stroke ().

CQI Model

Lean Six Sigma Green Belt Projects ()

Quality Indicators with Operational Definitions and Data Collection Method

Implementation of delirium screening and prevention/management strategies were monitored via electronic medical record reporting.

Clinical Setting

32-bed neuroscience step-down unit in a 900-bed quaternary care center

Program Objectives

Improve risk-adjusted rates to less than 1.0, meaning length of stay and mortality were better than expected
Greater than 80% adherence to delirium assessment using the Nursing Delirium Screening Checklist, nurse and provider completion of online interactive education modules, and 100% implementation of proposed care plan strategies