Implementing A Delirium Risk Assessment Protocol for Older Adults to Reduce Post-operative Delirium

PURPOSE This quality improvement project aimed to reduce post-operative delirium (POD) in patients aged 65 years and older in a post-anesthesia care unit (PACU) through the implementation of the Confusion Assessment Method (CAM) tool. BACKGROUND POD is a significant issue in the PACU, especially among older adults. POD can increase the length of stay in the PACU and hospital, and also increase rates of morbidity and mortality. Prior to this QI project, there was no standardized test being used to screen patients. METHOLOGY The Plan-Do-Study-Act (PDSA) cycle was used throughout the implementation of the confusion assessment tool to guide quality improvement efforts in the PACU. The QI project was implemented over an eight-week period and included a two-hour training session for nurses, weekly huddles, and implementation of the CAM tool in the required documentation workflow. Data collection was conducted of CAM completion rates and patients who had incidences of post-operative delirium compared to the pre-intervention audit of PACU postoperative patients. Audits were completed to identify nurses who were not compliant with the use of the CAM tool. RESULTS A total of 100 records were reviewed, and an 81% completion rate was achieved for use of the CAM tool. There was also a 23.1% decrease in POD incidents following the implementation of the intervention and a 5.70% reduction in PACU stay duration. This outcome suggests that the CAM tool helped to improve the staff's ability to identify at-risk patients, helped decrease the incidence of POD and provide improved postoperative interventions. IMPLICATIONS Although the reduction in PACU time was not statistically significant (t(185.64)=0.76, p= .45), the trend supports the clinical value of the CAM tool as part of routine PACU assessment for older adults at risk for postoperative delirium. Including the CAM tool in routine PACU documentation for older adults improves patient safety, guides timely interventions, and encourages the use of a standardized risk assessment method. Future quality improvement projects aimed at early detection assessment tools may benefit from these findings.