Registed Nurses' Association of Ontario

Delirium Education and CAM screening-Delirium BPG Implementation

Christina Huntington NP, MN, BAGer., GNC (c)
Niagara Health

Summary of fellowship:
I had the opportunity to implement the newly revised BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care, with a focus on delirium education and screening throughout the Niagara Health organization. A previous system gap analysis showed areas for improvement in delirium and CAM education, documentation and prevention and management interventions. The staff education created in the fellowship includes an online PowerPoint show, as well as bedside resources for every patient chart which includes a copy of the Confusion Assessment Method (CAM) screening tool, delirium algorithm, and non-pharmacological nursing interventions. Floor and nursing pod resources were also created to further support the staff, and enhance sustainability, which includes the newly created delirium order set, family and patient delirium information pamphlet, and an SBAR tool for delirium and CAM reference.

My overall learning goal of this fellowship was to acquire personal knowledge and experience in implementing a BPG, specifically Delirium, Dementia and Depression in Older Adults: Assessment and Care. In the process, I had also hoped to acquire knowledge on how to successfully engage frontline staff, in order to build capacity with evidence based practice and skills in knowledge transfer, for the successful uptake and implementation of the DDD BPG. I was fortunate to have attended a two day education conference to enhance my skills as an educator and learn skills such as positive communication and providing constructive feedback to facilitate these goals. I also gained knowledge in the evaluation process of the impact to patient care with the successful implementation of the DDD BPG with creating an audit tool, and working closely with the floor managers, educators and frontline staff.

In the data that has been collected, it was shown that there was a slight decrease in falls and restraint use with the implementation of the non-pharmacological delirium prevention and management interventions. Within the organization, there is currently a revised least restraint initiative, as well as a falls reduction initiative, which work together with the delirium education to provide up to date best practice guidelines for managing elderly patients with delirium in hospital. Family members were also encouraged to have an information tool to provide them further guidance for their hospitalized family member.

Within the organization, the ACPF was very well received as we are a BPSO, and there had been previous work in delirium. Key stakeholders were encouraged that the fellowship would allow the delirium work to continue, and that it would incorporate the most recent updated best practice information from the updated BPG. In conversation with staff, soft data shows that these interventions were shown to be useful and positively received by staff, and had positive outcomes in managing patients with delirium, and offering strategies to families of patients with delirium.

Overall Experience:
The RNAO ACPF was an amazing opportunity to work on a project that I feel very passionately about. Working in geriatrics for most of my nursing career has given me the insight into providing the best possible care to elderly patients that we can, and delirium prevention and management is one of those key care initiatives. Creating and providing delirium education to front line staff, as a care initiative greatly supported by senior management has been a great achievement in my nursing career. In my many discussions with staff, seeing the acknowledgment of the importance and severity that delirium can have on our elderly patients was a very rewarding experience.