Implementing a Delirium Protocol Bundle for Older Adult Postop Patients With Hip Fracture.

Abstract

Background: Older adult patients with hip fractures are three times more likely to develop delirium on the first postoperative day. Delirium results in higher rates of functional decline and increased discharges to nursing home placement. Lack of an evidence-based delirium assessment/intervention protocol negatively affects patient recovery and discharge destination. Objective: The project aim is to decrease delirium prevalence through the implementation of an evidence-based delirium assessment/intervention protocol bundle. Methods: Participants in this pre-post implementation design pilot project included postoperative patients with hip fractures aged 50 years and above (N = 22) admitted to an orthopedic unit of a community hospital in south central Pennsylvania. Data were collected on the number of patients with documented delirium symptoms and delirium protocol bundle in place as compared with the number of patients with documented delirium symptoms in the same time frame of the previous year without delirium protocol bundle in place. Results: Implementation of the delirium protocol bundle resulted in a 68% delirium prevention rate, 27.5% reduction in delirium incidence on the first postoperative day, and a 36% increase in discharges to rehabilitation centers compared with long-term nursing home placement. Conclusion: Implementation of a delirium protocol bundle resulted in a clinically significant decrease in delirium prevalence. Implications for Nursing: The delirium protocol bundle provides an evidence-based resource to improve patient outcomes and enhance nurses' professional practice.