Feasibility Testing of a Technology Application at the Point of Care

Wednesday, 1 August 2012: 8:50 AM

Beth Ann Swan, PhD, CRNP, FAAN
Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA

Learning Objective 1: Discuss the facilitators and barriers identified by bedside nurses when incorporating delirium screening tool into an EMR at the point of care with evidence-based interventions.

Learning Objective 2: Describe the effect of point of care delirium screening by nurses on recognizing and managing delirium and decreasing adverse events in postoperative older adults.

Purpose: Delirium is under-recognized and not documented by nurses in over 85% of patients who are delirious.  Nurses play a critical role in screening for delirium because they provide 24-hour care and see the patient in a variety of circumstances.  Failure to recognize delirium can lead to serious adverse events.  The purpose of the study was to determine the effect of screening with the Confusion Assessment Method (CAM) on the recognition and management of delirium by nurses and to determine the effect of screening with the CAM on clinically recognized adverse events including falls, pressure ulcers, and restraint use in postoperative older adults undergoing hip and knee surgery.

Methods: The study employed a pre-post design with older adult patients undergoing elective hip and knee surgery.  The post-intervention phase incorporated the CAM with score alert system into a hospital-based EMR for identification of delirium at the point of care. The main powered outcome was recognition of delirium.  Secondary outcome measures were clinically recognized adverse events.

Results: The pre-phase included 161 subjects.  Eight patients had 1 positive CAM each, 1 patient had 2 positive CAMs, and 2 patients had 3 positive CAMs.  This was expected in this healthy, elective surgery population.  One subject fell post-operatively, 2 subjects developed pressure ulcers, and no subjects were restrained.  In the pre-phase, none of those patients with a positive CAM was identified by nurses as potentially suffering from delirium.  The post-phase included 120 subjects.  In the post-phase 1 of 4 CAM-positive patients were also identified by a nurse. But in addition, the nurses also identified an additional 9 patients as suffering from delirium.

Conclusion: Feasibility was established for incorporating the CAM with score alert system into the EMR.  Nurses did use the CAM, did recognize delirium (confirmed by the RA), and implemented the recommended evidence-based interventions.