PROCESS IMPROVEMENT TO REDUCE THE INCIDENCE OF DELIRIUM IN AN OVERFLOW UNIT

Abstract Problem: This quality improvement project aims to reduce the incidence of hospital-acquired delirium in an overflow unit, which serves a diverse patient population from medical-surgical and telemetry microsystems. The unit averages 96 delirium episodes annually, costing approximately $3,456,000. The goal is to reduce delirium incidence by 25%, decreasing monthly cases from 8 to 6 by October 31, 2024, and annual cases to 72 by April 2026. Context: Delirium is a prevalent and severe neuropsychiatric syndrome that significantly affects older hospitalized patients, characterized by acute disturbances in attention, awareness, and cognition. Interventions: The project introduced a bundle of four interventions over four months to prevent delirium in overflow units: staff education using the Confusion Assessment Method (CAM) tool; environmental modifications, such as placing clocks on bedside tables; patient engagement strategies, including increased daytime mobilization; proactive monitoring protocols, with monthly audits to assess delirium incidence. Measures: Outcome measures included the incidence of delirium. Process measures included pre- and post-intervention staff surveys to assess baseline and comparative knowledge (n=30). Weekly delirium audits were conducted and analyzed over four months. Results: Interim results indicate increased staff knowledge in identifying and preventing delirium (n=30), with a reduction in the incidence of delirium in 2 patients, resulting in savings of $72,000. RN surveys (n=117) post-implementation indicated 100% satisfaction. Conclusions: The project demonstrated the necessity of nursing assessment and delirium prevention interventions. Clinical Nurse Leaders (CNLs) need to continuously advocate for evidence-based projects to prevent delirium and its high costs, particularly in heterogeneous units like overflow units.