Significance & Background: Delirium affects a significant number of hospitalized adults each year resulting in negative patient outcomes and family caregiver distress. Clinical identification of delirium by nurses and use of family caregivers as part of a multicomponent delirium prevention strategy are not consistently implemented in the practice setting despite being best practice.Purpose: An interdisciplinary team in this 800 bed level one trauma center has been created to create and implement this best practice delirium protocol. The purpose of this initiative was to incorporate the family caregiver into this existing multicomponent delirium prevention, detection and management protocol. Interventions: Consistent implementation of basic care interventions and personalized care for at risk patients can help to prevent delirium in the acute care setting. The team has focused on staff education on the use of the CAM (confusion assessment method) as a consistent delirium-screening tool as well as early implementation of the protocol. Use of non-pharmacological interventions can be effective in the prevention of delirium as well as in reduction of the episode if it does occur. Family caregivers can be educated and engaged by the nurse to help create a personalized plan of care. Evaluation: Evaluation of the protocol has been measured by hospital safety and quality metrics such as falls, length of stay, mortality rates as well as patient experience scores.Discussion: Oncology patients are at high risk for delirium and require a team approach to identify this medical emergency early and to begin evidenced based interventions. Cancer care is most often done in the out patient setting making partnerships with family caregivers even more critical. Non-pharmacological interventions are simple and easily taught to family caregivers. These interventions include encouragement of food and drink, ambulation, cognitive stimulation/orienting strategies and protected rest. This opportunity of partnership is missed by nurses and contributes to poor outcomes.Innovative: The identification and treatment of delirium is becoming an international priority as its negative impact to quality of life and the bottom line become undeniable. This medical emergency requires a team approach that includes the family caregiver and a personalized plan of care. The oncology nurse is poised to be an important team member to create positive outcomes.
Eannielo, M.K., Waszynski , C. M., & Milner, K. A. (2017, May). Delirium prevention, identification and management in the oncology setting: A unique partnership with patients and their family caregivers. Poster session presented at the ONS 42nd Annual Congress, Denver. CO.
ONS 42nd Annual Congress
Oncology Nursing Society