Linking Evidence to Practice: The Delirium and Fall Connection

Tuesday, 19 November 2013: 8:50 AM

Joanne Chapman, RN, BSN, MSN, MEd
Professional Practice, Maine Medical Center, Portland, ME
Deborah Bachand, RN, BSN, CNA, BC
R-6, Maine Medical Center, Portland, ME
Cynthia Honess, RN, MSN
Center for Clinical and Professional Development, Maine Medical Center, Portland, ME

Learning Objective 1: Discuss how nurse driven research led to interdisciplinary practice and increased patient safety.

Learning Objective 2: Discuss the process for implementation of research findings into practice

Patient falls continue to present a threat to patient safety and increase morbidity, mortality and the cost of health care.  Falls can be related to many risk factors for patients in a hospital including acute illness, an unfamiliar environment and medications.  After reviewing all data related to patient falls, we posed the question as to whether unrecognized or undiagnosed delirium could possibly link to these falls.   Lakatos, B.E., et al, (2009) work at Massachusetts General Hospital, found 96% of patients who fell had evidence of delirium and 75% of the time the delirium went undiagnosed.  This evidence became the basis of two research studies and a comprehensive plan to integrate evidence related to delirium assessment and interventions into practice.

In 2010, an interdisciplinary collaborative formed to replicate the Lakatos study and found similar results.  Unrecognized delirium occurred in over 60% of our patients, with delirium present 71% of the time.  Members of the team included a geriatrician, Nurse Practitioner, Clinical Nurse Specialists and Nursing Director co-chairs of the falls committee.  These results led to a comprehensive action plan that included education, implementation of the Confusion Assessment Method (CAM) tool, and development of a Delirium Tool Kit, leveraging and purchasing technology and continuous monitoring of practice.  This approach has led to a common language and understanding about delirium among interdisciplinary clinicians which has aided in improved safety for our patients. 

This comprehensive interdisciplinary approach has led to an increase in identification of delirium and, consequently, a consistent decrease in fall rate.  A re-replication study was completed in 2012 to evaluate patient falls and delirium connection. Results indicate an increase in identification of delirium as well as a lower fall rate.