Electronic Medical Record (EMR) Documentation of Delirium and Injuries in Postoperative Arthroplasty Patients

Monday, 30 July 2012

Susan K. DeCrane, PhD, RN1
Mary K. Hicks1
Lori Stark, BSN2
Beth Johnston, PharmD3
(1)School of Nursing, Purdue University, West Lafayette, IN
(2)Orthopedic Division, St. Vincent Health, Indianapolis, IN
(3)Department of Pharmacy, St. Vincent Health, Indianapolis, IN

Learning Objective 1: describe methods of extracting information from EMR to conduct risk reduction in postoperative older adults

Learning Objective 2: describe common postoperative risks that result in poorer outcomes following hip and knee arthroplasty


The purpose of this presentation is to examine incidence of delirium and injuries in the postoperative period following both elective and non-elective hip and knee arthroplasty procedures in older adults.  A secondary purpose is to determine documentation related to the increased need for nursing surveillance to reduce patient falls and injuries.


A one-month retrospective study was conducted using electronic medical records (EMR) and an audit instrument developed to assess patient risk factors for delirium. Data extraction included accuracy of delirium documentation in medical records and nursing records as well as complications as a result of delirium episodes, including falls and other injuries that could negatively impact patient outcomes.


One hundred and six (106) patient medical records comprised the sample, with 82 elective arthroplasty procedures and 24 procedures as a result of fracture.  Preliminary results show a very high rate of delirium particularly in fracture patients. Delirium episodes resulted in significant expenditure of staff resources. Nursing documentation for delirium in EMR is more accurate and timely than other medical and surgical documentation. Injuries related to confusion occur most often related to IV line disruption and agitation, which may contribute to slower recovery and longer length-of-stay.


Postoperative delirium is a common complication of surgery in hip and knee arthroplasty patients. Documentation of delirium in nursing electronic medical records (EMR) provides better assessment of at-risk patients than other EMR and can help identify factors needed for risk reduction of injuries and other negative outcomes.