Semester

Fall

Date of Graduation

2024

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Not Listed

Committee Chair

Aaron Ostrowski

Committee Member

Christine Mott

Committee Member

Laura Ostapenko

Abstract

Postoperative delirium (POD) is a common occurrence, effecting nearly 61% of the surgical population recovering from anesthesia. POD increases risk of morbidity and mortality leading to prolonged hospital length of stay by 0.8 to 7.3 days and increased costs by $1,551 to $23,698 (Masharaf et al., 2022; Sethi, 2021). An academic medical center in northern West Virginia (WV) lacks a structured practice/protocol to identify high risk patients and assess POD. An evidence-based solution was developed based on the PICO question: Does a multidisciplinary approach to perianesthetic care utilizing a brain health screening tool, compared to lack of a screening tool, improve rates of postoperative delirium in the at-risk geriatric population? An evidence-based intervention recommending a structured plan of perioperative care was implemented to prevent adverse outcomes and increase quality of care. The setting for this project was the perioperative evaluation center (PEC) and post-anesthesia care unit (PACU) of an academic medical center. Advanced Practice Providers (APPs) of the PEC utilized the Ascertain Dementia 8 (AD8) screening tool to assess patients with ASA scores of III-IV for POD risk. Preoperatively, nurses applied identification bracelets to high-risk PEC patients for anesthesia staff to easily recognize high risk patients. Certified registered nurse anesthetists (CRNA) and anesthesiology residents used findings from the screening tool to plan anesthetics minimizing risks for POD. Postoperatively, PACU staff assessed patients for POD and documented findings according to the Confusion Assessment Method (CAM) and Richmond Agitation and Sedation Scale (RASS) for delirium. Results of the project: Preintervention: Ninety-seven patients were assessed for delirium in the PACU with the CAM-ICU and RASS tools, concluding increased rates of delirium with age. Postintervention: Six hundred and forty-nine patients were screened by PEC professionals during the three-month period of project dissemination. Of that total, one hundred and twenty-four patients were screened high risk for postoperative delirium; fifty of these patients were accurately assessed in the postoperative period using the CAM-ICU and RASS tools. Based on the findings, preoperative screening did not minimize the risk for delirium in the post anesthesia care unit but created awareness to positively alter the anesthetic care plan and provide referral to the facility’s memory clinic. Continuing education should be implemented to inform the perioperative staff of the screening for postoperative delirium.

Share

COinS