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Pain Management 2019 & Internal Medicine 2019
International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X
Page 58
JOINT EVENT
7
th
Edition of International Conference on
Pain Management
8
th
Edition of International Conference on
Internal Medicine &
Patient Care
&
March 25-26, 2019
Rome, Italy
Int J Anesth Pain Med 2019, Volume 5
DOI: 10.21767/2471-982X-C1-006
Improving delirium recognition and prevention on the
UTMB ACE unit: Preliminary findings
Olusola Onoviran, Hommel Erin and James Coleen
University of Texas Medical Branch, USA
Background: Delirium is a global disorder of cognition
with an acute and fluctuating course which often occurs
in the setting of a medical condition. It is considered
a medical emergency with increased morbidity and
mortality. Existing literature supports a multidisciplinary
approach to reduce incident delirium in the hospitalized
older adult by recognizing predisposing factors and
modifying potential contributors. We aim to identify the
frequency and accuracy of incident delirium for patients
admitted to the UTMB Acute Care for Elders Unit and
assesses feasibility of implementing a multidisciplinary
program to reduce delirium risk while hospitalized.
Project description: To assess the frequency and
accuracy of incident deliriumon the ACE unit, admissions
between September 2017 and November 2017 were
screened. Patients with delirium on admission were
excluded from evaluation as the focus was on preventing
rather than treating delirium. Patients were also excluded
if not followed by the geriatric team as interventions
were directed through their care. 10 patients per month
were evaluated in detail to determine the prevalence
of predisposing and precipitating factors for delirium,
nursing and physician documentation of incident delirium
features, and actual diagnosis of delirium. A diagnosis
was considered positive if the nurse documented a
positive delirium screen OR the physician identified
features of delirium. A multidisciplinary prevention
plan was proposed but implementation was delayed as
discussed below
Outcome:
Of the 30 patients analyzed, average age
was 81.8years (range 71-99 years) with 70% population
(female). Incident delirium was diagnosed in 3 (10%).
The diagnosis of delirium was made based on faculty
documentation. In all cases resident documentation
suggested mental status change, without using the
delirium diagnosis. Nurses failed to identify delirium
in all cases. Each of these identified patients were
post-operative females with evidence of dehydration
by laboratory testing (BUN/Creatinine >18). 2 out of
3 patients- 67% also had psychoactive medication
treatment, hearing impairment, age greater than 90,
and post-operative complications. In patients without
delirium, 48% were on psychoactive medications, 11%
with hearing impairment , mean age was 80.9 years and
only 11% had complicated hospital course,67% were
female and 74% had BUN/Creatinine >18 .
ofonovir@utmb.edu