| Learning Objective #1: Discuss the impact of collaboration by three advance practice clinical nurse specialists in improving patient outcomes | |||
| Learning Objective #2: Identify components of the intervention pathway for depression and delirium in the coronary artery bypass graft patient |
Post cardiotomy delirium and depression in patients 65 years or over are multifactorial and widely under diagnosed. Approximately 367,000 Americans undergo Coronary Artery Bypass Graphs (CABG) annually with a mean age of 66 years, with nearly 30% of the patients over 70 years of age. An extensive multidisciplinary literature review on post cardiotomy delirium and depression revealed that the problem is grossly under treated or fragmented treatment options exist. Delirium has been consistently documented in 31% of patients studied resulting in exacerbated complications such as ischemia, arrhythmias, and incomplete healing of the sternum. Depression has been well documented although comparable statistics are not available. The literature review revealed that both prevalence and severity of delirium and depression might be amenable to reduction by formulating a comprehensive treatment plan in and indicated that nurses have a fundamental role in reducing the incidence of postoperative complications through patient education, motivation and early detection of potential problems. Advanced Practice Clinical Nurse specialists in Cardiology, Gerontology, and Psychiatry from a multihospital system with a cardiac surgery unit are collaborating on a quantitative research project to identify appropriate interventions to improve outcomes for these patients in the current economically challenged health care environment.
The goal of this project is the creation of a multidisciplinary intervention pathway which can be utilized to decrease the intensity and severity of post cardiotomy delirium and depression over the continuum of care by pre and post operative teaching of patients and families, early identification of symptoms with implementation of appropriate interventions, discharge planning which focuses on the cognitive changes and follow-up post discharge. Outcomes for these patients include decreased: intensity of symptoms, length of stay, mortality and morbidity, and health care costs.
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