Authors (including presenting author) :
Lau CY(1), Lin YF(1), Chow PY(1), Yiu KC(1), Chan PM(1), Hung KK(1)
Affiliation :
(1) Orthopaedic and Traumatology Department, Princess Margaret Hospital
Introduction :
Delirium is a highly prevalent problem for elderly in-patients. It is elicited by underlying altered physiological conditions. It is associated with higher morbidity and mortality, increasing in length of stay and old age home admissions. However, the diagnosis is often missed in acute care settings. The corresponding care and documentations are sometimes incomplete as well. Moreover, elderly in-patients who require Orthopaedic surgery are more vulnerable to develop delirium due to the additional risk factors such as pain, immobility, use of opioids, receiving surgery and anesthesia. The NICE guideline 2019 suggested regular screening for at risk patients at least daily. Yet, there is a lacking of screening tool and screening routine for delirium in Princess Margaret Hospital.
Objectives :
1) To find out the most suitable screening tool for delirium for post-operative elderly in-patients
2) To establish a nurse-led screening routine
3) To design a multi-component nursing intervention (screening + identifying risk factors + caring package)
4) To provide an effective way for nursing documentation (an immediately-ready template) of delirium and its corresponding care
5) To incorporate the related nursing documentation into the hospital-based electronic platform for nursing documentation, named "Patient Clinical Handover System" (PCHOS)
6) To benchmark with the international standards of care
7) To enhance the recognition, prevention, diagnosis and treatment of delirium
Methodology :
An attempt has been done to systematically review the available evidence in December 2019 using The Johns Hopkins Nursing Evidence-based practice guidelines. The PICO format was applied.
Result & Outcome :
1) The most suitable validated tool (4AT) was selected for its feasibility and good psychometric properties.
2) A screening routine was established by ward nurses for operative cases with age 65 or above. It is piloted in B5 ward since 6 Apr 2020, and promulgated to the whole department since 11 sept 2021
3) A multi-component nursing care plan template was established since 3 March 2021, and it was made available in the electronic platform "PCHOS" since 5 July 2021
4) The electronic nursing documentation template could be completed < 1 minute.
5) The use of 4AT promotes a Nurse led screening on delirium. It is benchmarking with the NICE guideline 2019
6) Plan to calculate the prevalence, Odds ratios and Number Needed to Treat (NNT) for effectiveness of the program
