Delirium is Under-Detected on Routine Screening with the CAM: a Sub-Study from World Delirium Awareness Day

Abstract

Delirium is an acute change in mental status that affects more than 2.6 million hospitalised adults annually. Patients who experience delirium suffer extended hospital stays and increased mortality and morbidity. Delirium screening is fundamental in driving prevention and early detection. This project aimed to examine delirium assessment, recognition for patients over 18, barriers to implementing delirium prevention treatment, and report qualitative findings for delirium care. In mid-March 2023, 11 Clinical Nurse Leaders in the Southeast Region of the United States participated in a study to increase awareness of delirium called World Delirium Awareness Day. Data was collected using an online survey to assess unit census, the number of CAM assessments, and positive CAM screening at 8:00 A.M (+/- 4 hrs) and 8:00 PM (+/- 4 hrs). Patients were defined as having delirium if their electronic healthcare record documentation reflected at least one occurrence of a positive CAM score. The survey comprised 39 “select all that apply” questions and three open-ended questions. Results show 418 (64%) CAM assessments were completed. Greater compliance was found during the morning assessment than the evening shift. Differences in nursing practice and opinions were also identified between General and High Acuity Units. Among patients receiving assessments, delirium recognition was 2% (8:00 A.M.) and 3% (8:00 P.M.). There was a significant difference in the use of multi-professional daily goals between the two unit types as a non-pharmacologic intervention for delirium (General: 0% vs. High Acuity: 100%, p=.003). Barriers identified: shortage of personnel, interprofessional communication gaps, and difficult-to-assess patients. Recommendations for delirium care include staff education and implementing an EHR tool to remind nurses to assess and document delirium. Findings from this study reveal the need for staff education, support, and the enhancement of resources to promote delirium prevention.