Detecting Delirium in Hospitalized Elderly Patients: A Review ofPractice Compliance

摘要

>Background: The Ontario Senior Friendly Hospital Strategy recognizes delirium prevention and management as a top priority and recommends implementation of delirium screening as well as management protocols. This strategy proposes that hospitals monitor 2 specific indicators: (1) rate of baseline delirium screening and (2) rate of hospital-acquired delirium. >Objective: To (1) determine compliance with the Ontario Senior Friendly Hospital Strategy indicators; (2) describe the use of pharmacological and nonpharmacological interventions for management of delirious patients; and (3) identify predictors of screening compliance. >Methods: We conducted a retrospective review of patients aged ≥65 years admitted to 4 different inpatient units for ≥48 hours. Data were extracted for 7 two-month time blocks chosen between September 2010 and October 2013, following the implementation of various geriatric and delirium related initiatives at the hospital. >Results: A total of 786 patients met study inclusion criteria. Overall, 68.2% had baseline delirium screening (indicator 1), with screening rates increasing over time (P < .001). Inpatient unit and year of study were both statistically significant predictors ofdelirium screening. Among those screened, the overall rate of hospital-acquireddelirium was 17.2% (indicator 2). Early mobilization and device removal were themost common nonpharmacological interventions, while initiation of anantipsychotic and discontinuation of benzodiazepines were the most commonpharmacological interventions. >Conclusions: Although the rates ofbaseline delirium screening have significantly increased over the sampled timeperiod, rates are still below the averages referenced in other literature. Ourstudy suggests we need additional efforts to improve compliance with deliriumscreening in our institution.