Paper
Thursday, July 22, 2004
This presentation is part of : Gerontological Nursing
Delirium in the Hospitalized Elderly: Clinical Indicators Found in Medical Records
Diane Elmore, RN, APN, MSN, FNP-C, Department of Nursing, Great Basin College, Elko, NV, USA and Margaret Louis, RN, PhD, School of Nursing, University of Nevada, Las Vegas, Las Vegas, NV, USA.
Learning Objective #1: List the key indicators of acute delirium in hospitalized patients
Learning Objective #2: Discuss the need to recognize signs of delirium so appropriate interventions can be made to reduce, if not eliminate, the long-term outcomes of untreated delirium
Objective: The purpose of this descriptive retrospective study was to determine if hospital patient records contain sufficient diagnostic evidence to identify elderly patients at risk to develop delirium within 72 hours of hospital admission, and when the criteria for delirium are documented is a diagnosis made and treatment instituted? Design: Descriptive-retrospective study. Population: Patients 65 and older admitted to rural hospitals without prior diagnosis of mental illness or delirium. Sample: The charts of 100 randomly identified patients. Setting: Rural hospital in Southwest United States Year: July 2001 to June 2002. Variables Studied Together: Delirium, elders hospitalized for acute illness. Methods: Evidence-based criteria were used to assess the documentation of recorded signs and symptoms of delirium (acute confusion) in patient’s hospital records and its diagnosis and treatment.

Findings: The review indicated that there was sufficient evidence, based solely on the descriptors and clinical information, in the medical record to make a diagnosis of delirium. Findings also revealed that 16 of the subjects met all the clinical criteria to receive a medical diagnosis of delirium, however, only one of these patients (6%) was diagnosed as having delirium. Additionally, delirium signs increased significantly over the 72 hour period.

Conclusions: Patients’ hospital records well document, the signs of delirium and that these signs of delirium increases rapidly through at least 72 hours after admission. However, neither nurses nor physicians recognize and appropriately intervene for hospitalized older patients who have signs of delirium

Implications: The importance of these findings is related to assuring nurses and physicians are current in their ability to not only record observations but also recognize and treat delirium (acute confusion) when it occurs in hospitalized patients. To fail to do this puts these patients at great risk for long-term negative outcomes and reduced independence and quality of life.

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