Delirium is a serious medical condition in the hospital environment and prevention is the best method for combating this life-altering condition. Froedtert Hospital patients were showing increasing rates of delirium and are benefiting from increased intervention. Evidence supports the use of an advanced practice registered nurse (APRN) consultation for the treatment of delirium. Two quality improvement projects were conducted using an APRN consult to increase knowledge of the delirium bundle elements, increase staff adherence to delirium treatment interventions and to decrease delirium rates, delirium duration and length of stay (LOS).
An acute care unit and an intensive care unit were selected as the intervention settings. The APRN delivered educational sessions with a pre- and post-knowledge questionnaire. The APRN performed consultations over a six-week timeframe on patients with positive delirium screenings. These included a chart review, care recommendations focusing on the delirium bundle elements and collaboration with bedside staff. The pre- and post-knowledge questionnaire showed that staff value the use of the APRN consult and showed an increase in understanding of delirium treatment interventions. The APRN consultations showed mixed results in the adherence to bundle elements. The ICU setting saw a 1% decrease in delirium rates and no significant change in LOS. The acute setting saw no change in delirium rates, however there was a decrease in the duration of delirium and a decrease in LOS by 2.7 days per patient.
Use of an APRN consult provides value in improving patient outcomes. For the acute care setting, use of an APRN consult could potentially save the organization $379,080 annually in cost avoidance. In addition, continued use of the APRN consult could provide improvements in delirium rates, delirium duration and LOS. A replication project is planned in 2024 to evaluate effectiveness on a broader scale.
