Delirium Management for Beth Israel Deaconess Hospital in Milton

1. Introduction

- Delirium in the hospital setting is a common and challenging issue resulting in increased morbidity, increased length of stay, significant distress for the patients and families and long term neuropsychological deficits & functional decline, etc.

-  We have started a delirium intervention project with EMR tool (b-CAM) in order to achieve rapid recognition of delirium and provision of proactive systematic delirium intervention. Now we are considering nursing screening implementation for all admission and need to develop a workflow for nurses and licensed independent practitioners(LIP) to prevent and manage delirium more effectively.

2. Target Patients for Delirium Intervention

1) Patients with B-CAM positive by nursing screening (among all admissions)

2) Patients with any of *majorrisk factors/predisposing factors for developing delirium

Risk factors/predisposing factors includes ;

- age ( >70)

- cognitive impairment (including developmental disorder)

- sensory impairment (vision, hearing)

- mental illness

- substance use

- malnutrition

- home opioid or benzodiazepine use

Precipitating factors includes ;

- acute myocardial infarction

- decreased ability to care for ADLs

- dehydration

- electrolytes imbalance

- failure of 1 or more organ(s)

- infection

- limited mobility

- substance intoxication or withdrawal

- uncontrolled pain

3. Next phase : Developing an interdisciplinary workflow for Delirium Intervention

- Currently we are working to develop an interdisciplinary workflow including b-CAM integration on Meditech, nursing delirium screening and implementation of delirium precaution/intervention, pharmacologic treatment order set for LIPs.

4. Final : Expected Outcomes from Delirium Intervention including but not limited to…

- Reduction in delirium incidence, mortality

- Reduction in Length of Stay, cost for care

- Improved prevention of function decline

- Improvement in quality of care for older patients, including outcome such as falls

- Increased patient and family satisfaction with care

- Recognition of the hospital as a Center of Excellence in provision of geriatric care

- Reduction in use and costs of hospital services