Use of a Tailored, Multifaceted Educational Approach for Prevention and Early Detection of Delirium in Hospitalized Elderly Patients

Aim: The aim of this scholarly project was to implement and evaluate the efficacy of a tailored, multifaceted nursing educational program in prevention, early detection leading to early management of delirium in older adults aged 65 and above.

Background: Delirium is a medical emergency which compromises patient safety due to its many negative consequences such as falls, prolonged hospitalisation, and increased use of restraints. Delirium is often missed or diagnosed late by physicians. As the frontline in patient care, nurses play an important role in early delirium detection and prevention. Therefore, educating nurses on delirium prevention and clinical application of a delirium screening tool is deemed necessary in caring for the elderly patients aged >65.

Design: This was a three-phase study employing two-independent group pre-post design conducted at two mixed acute general medical/surgical wards in a large tertiary hospital.

Methods: Phase 0 was to establish nurses’ baseline knowledge of delirium, incidence of delirium, falls, restraint use, and length of stay amongst the eligible patients. Phase I was to implement the educational program which comprised of theoretical and practical components to the registered nurses in the two wards. Trained nurses then applied modified 4AT and delirium care bundle to eligible patients in Phase II.

Results: Total of 61 nurses were involved in the training. There was significant improvement in nurses’ knowledge of delirium after training, which was sustained at one month later. A total of 100 patients were recruited. The incidence of delirium was 8% in phase 0 and 6% in phase II. Patients with delirium had longer length of stay than patients without delirium. There was no significant difference in falls, restraint use and length of stay.

Conclusions: A multifaceted delirium educational program improved nurses’ knowledge in delirium screening and prevention. A longer study period for larger enrolment of patients is recommended to evaluate the longer term retention of knowledge and the effects on patient care.

Keywords: Delirium, delirium screening, delirium prevention, 4AT, delirium bundle, delirium education.