Delirium detection and management in older adults: An evidence-based practice pilot

Delirium is highly prevalent and grossly underdiagnosed in the acute care setting, especially in older adults. Despite evidence to support strategies to identify and manage delirium, non-intensive care areas often lack standardized processes. The aims of this project were to identify and implement evidence-based practices (EBPs) for detecting and managing delirium in non-ICU patients aged 65 years and older who were admitted with a hip fracture diagnosis. Guided by the Iowa Model for EBP Implementation and Sustainability, a 16-week pilot on a 40-bed surgical unit was conducted. Workflows and processes were developed by a multidisciplinary team that included clinical nurse champions. Key interventions included twice-daily delirium screening using the Brief Confusion Assessment Method (bCAM), the creation of a new delirium care plan, and the optimization of a geriatric order panel with both pharmacologic and non-pharmacologic options. Following the 16-week pilot, delirium identification increased by 100.7 %, with a positive screening rate of 29.7 %, closely aligning with reported prevalence rates in the literature. There was 100 % activation of the delirium care plan for patients who screened positive for delirium during their admission. Patient outcomes, including falls, restraint use, and length of stay, were monitored during the project, but were not significantly impacted. This project demonstrates the integration of evidence-based strategies for delirium into non-ICU care spaces. The multidisciplinary approach and inclusion of bedside nurses as change champions foster sustainability and scalability, creating an initial pathway for Age-Friendly care. The project team achieved its goal of implementing evidence-based processes to improve the detection and management of delirium in older adults. Future work will focus on optimizing workflows and expanding this model across the health system.