Purpose:

To develop an evidence-based approach to prevent and manage delirium in orthopedic patients.

Significance:

New onset of delirium occurs in up to 33% of hospitalized patients with hip fractures and is independently associated with poor functional recovery, even after adjusting for prefracture frailty. Delirious patients have more adverse reactions to therapeutic doses of medications, fall more frequently, and develop more infections and pressure ulcers. Delirium complicates hospital stays for 2.3 million patients, increases the average length of hospital stay by 6 days, and accounts for greater than $7 billion of Medicare expenditures. There's a beginning body of knowledge that suggests prevention may be the most effective approach.

Methods/Description:

Two CNSs led an interdisciplinary team consisting of physicians, pharmacists, a staff nurse, an integrative therapy practitioner, a behavioral health CNS, and a quality specialist. This team developed an evidence-based protocol that focused on a risk-factor intervention strategy to reduce delirium occurrence. The protocol was piloted on orthopedic patients.

Findings/Outcomes:

The pilot was successfully completed, with over 55 patients being placed on the protocol. Baseline data, including length of stay, number of patients on restraints, and sitter use, were compared with the pilot data.

Conclusions:

A multidisciplinary, multicomponent strategy focusing on prevention may be the most effective approach for delirium.