Prevention of Delirium:! Acute Heart Failure! Bonnie L. Albert, DNP, ACNP-BC!
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1 Prevention of Delirium:! Acute Heart Failure! Bonnie L. Albert, DNP, ACNP-BC!
2 Delirium: Hospital Complication! Delirium: a disturbance of consciousness characterized by acute onset and fluctuating course of inattention accompanied by either a change in cognition or a perceptual disturbance, so that a patient s ability to receive, process, store, and recall information is impaired (Ely, 2012)! 112.5! 90! 67.5! 45! 22.5! 0! ICU! Hospital! Post-Op! Ventilated Incidence in Heart Failure: %! Types of Delirium: Hyperactive, Hypoactive, Mixed!
3 Outcomes of Delirium! downward spiral of functional decline, loss of independence, institutionalization, and death (Fong et al., 2009, p. 210) Delirium can become chronic, with permanent sequela, affecting quality of life (Fong et al., 2009) Delirium is implicated in Post ICU Syndrome/Dementia (Makic, 2016) Increased morbidity and mortality (HF) Increased risk of 30/90 day readmission (HF) Increased risk new nursing home placement (HF) Increased 90 day all cause mortality (HF) (Uthamalingham, Gurm, Daley, Flynn, & Capodilupo, 2011)
4 Post-Discharge Clinical Outcomes!
5 !! Costs of Delirium! Prevention Savings! U.S. alone: $4-16 billions dollars annually! Increased cost of care estimated to be $2500 per patient or 6.9 billion annually to Medicare (O Mahoney,, Murthy, Akunne, & Young, 2011)! Post discharge costs can be as much as $64, 421/patient (Leslie & Inouye, 2011)! NICE Clinical Guideline (2010, 2012, 2015) Incremental net monetary benefit of 8180 and 2200 pounds! Hospital Elder Life Program (Leslie & Inouye, 2011)! Estimated to have saved $125 million per year on 704 patients! Follow up Study: 7000 patients/6 units est. savings of $6.9 million!
6 Evidence for Prevention Protocols! Level I Evidence that all adults admitted to non-icu units should have non-pharmacological protocols! 31% reduction in risk of developing delirium through multi-component interventions (p< , 95% CI, )!!! (Thomas, Smith, Forrester, Heider, & Holly, 2014)! Joanna Briggs Institute! NICE Clinical Guideline! Prevention of delirium in hospitalized patients >18! 13 recommendations to assess and modify factors:! cognitive impairment, disorientation, dehydration, constipation, hypoxia, infection, mobility, medications, pain, nutrition, sensory impairment, sleep disturbance! ICU Evidence! 78% reduction in the risk of delirium (OR 0.22,p=0.001) (Smith & Grami, 2017)!
7
8 Delirium Education!
9 Major References! Dienger, J., Bass, L., Milne, J., & Rentz, C. (2013). Development of a delirium and dementia self-! efficacy scale. Presented at the Sigma Theta Tau International 42nd Bicentennial Convention! 2013, Indianapolis, Indiana. Retrieved from ! Gesin, G., Russell, B. B., Lin, A. P., Norton, H. J., Evans, S.. L., & Devlin, J. W.,(2012). Impact of a! delirium screening tool and multi-faceted education on nurses knowledge of delirium and! ability to evaluate it correctly. American Journal of Critical Care, 21(1), e1-e11. doi: /! ajcc ! National Institute for Health and Care Excellence (NICE). (2010). Delirium: Diagnosis, prevention, and management.! NICE Clinical Guideline, 103, 1-427! National Institute for Health and Care Excellence (NICE) (2012). Delirium:! Diagnosis, prevention,and management evidence update. NICE Clinical Guideline, 103, ! National Institute for Health and Care Excellence (NICE). (2015). Delirium, diagnosis, prevention,! management: Evidence review. NICE Clinical Guideline, 103.! Rivosecchi, R. M., Smithburger, P. L., Svec, S., Campbell, S. & Kane-Gill, S. L. (2015).! Non-pharmacological interventions to prevent delirium: An evidence-based systematic! Review. Critical Care Nurse, 35(1), doi: 4037/ccn ! Rivosecchi, R. M., Kane-Gill, S. L., Svec, S., Campbell, S., Smithburger, P. L. (2016). The! implementation of a nonpharmacologic protocol to prevent intensive care delirium. Journal of Critical Care, 31,! doi: /j.jcrc ! Smith, C. D., & Grami, P. (2017). Feasibility and effectiveness of a delirium prevention bundle in! critically ill patients. American Journal of Critical Care, 26(1), ! doi: /ajcc ! Speed, G. (2015). The impact of a delirium education intervention with intensive care unit nurses.! Clinical Nurse Specialist, doi: /NUR ! Thomas, E., Smith, J., Forrester, D. A., Heider, G., & Holly, C. (2014). The effectiveness! of non-pharmacological multi-component interventions for the prevention of! delirium in non-intensive care until older adult hospitalized patients: A systematic! review. JBI Library of Systematic Reviews, 12(4), ! doi: /jbisrir ! Wand, A. P. F., Thoo, W., Sciuriage, H., Ting, V., Baker, J., & Hung, G. E. (2014). A multi-faceted! educational intervention to prevent delirium in older inpatients: A before and after study.! International Journal of Nursing Studies, 51, doi: /j.ijnurstu !! Full Reference List Available Upon Request: albert_bonnie@yahoo.com Bonnie L. Albert, ACNP-BC!
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