§ Delirium affects 85-88% of patient in final 2 weeks of life.

§ Negative consequences:Increased emotional distressIncreased incidence of PTSD, depression, anxietyLoss of valued time with loved onesAdverse events such as falls

§ Misalignment with principles of hospice care.§ In the literature, nurses are requesting:

Up-to-date knowledge on deliriumEasy-to-use assessment tools implemented into routine practiceTwo studies identified provided:Use of education and an assessment tool was effective in improving delirium recognition

CONCLUSIONS

Delirium Education in Hospice Care: A Quality Improvement ProjectCynthia Sinchak MSN, RN, CHPN

University of Virginia School of Nursing

PURPOSE

REFERENCES/ACKNOWLEDGEMENTS1. Hosie A, Lobb E, Agar M, Davidson PM, Phillips J. Identifying the barriers and enablers to palliative care nurses’ recognition and assessment of delirium symptoms: A qualitative study. J Pain and Symptom Manage. 2014;48(5):815-830. doi:10.1016/j.jpainsymman.2014.01.008. 2. Close JF, Long CO. Delirium opportunity for comfort in palliative care. J Hosp Palliat Nurs. 2012;14(6):386-394. doi:10.1097/NJH.0b013e31825d2b0a. 3. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911-922. doi:10.1016/S0140-6736(13)60688-1. 4. Lawley H, Hewison A. An integrative literature review exploring the clinical management of delirium in patients with advanced cancer. J Clin Nurs. 2017;26:4172-4183. doi:10.1111/jacn.13960. 5. Harrison A, Smith R, Champagne M, Martin B, Pursley J, Hendrix C. Implementation of a delirium assessment protocol in an inpatient hospice setting. J Hosp Palliat Nurs. 2016;18(3):227-232. doi:10.1097/NJH.0000000000000237. 6. Lau CY, Yeager J, Chao J, Holt B, Fong T, Rathfon M, Douglas V, Rogers S. Got delirium? Implementation of a multi-disciplinary delirium reduction pathway. Poster presented at: Society of Hospital Medicine Annual Conference; April 8-11, 2018; Orlando, Florida. 7. Hospice Care. National Hospice and Palliative Care Organization (NH. https://www.nhpco.org/about/hospice-care. Accessed June, 2018. 8. Hosie A, Agar M, Lobb E, Davidson PM, Phillips J. Improving delirium recognition and assessment for people receiving inpatient palliative care: A mixed methods meta-synthesis. Int J Nurs Stud. 2017;75:123-129. doi:10.1016/j.ijnurstu.2017.07.007. 9. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic and continuous delirium assessment in hospitalized patients: The nursing delirium screening scale. The J Pain Symptom Manage. 2005;29(4):368-375. doi:10.1016/j.jpainsymman.2004.07.009. 10. Hosie A, Lobb E, Agar M, Davidson PM, Chye R, Lam LT, Phillips J. palliative care inpatient units. International J Palliat Nurs. 2016; 22(1):13-21. (2016). Measuring delirium point prevalence in two Australian doi:10.12968/ijpn.2016.22.1.13.

Pre and Post-Test Results:§ Paired t-test§ Statistically significant (p= 0.009)

Delirium is:§ Complex, underdiagnosed neuropsychiatric

syndrome§ Occurs with high frequency at end of life with

negative consequences§ Nurses have expressed a need for:

EducationEasy-to-use assessment tools

§ This quality improvement project showed:Statistically significant results providing delirium education and implementing the Nu-DESC Assessment tool

§ Moving Forward: A routine assessment tool in placeImprove patient safetyImprove quality end-of-life care

§ Further study is needed to address:Similarities between hypoactive delirium and the end of life process

INTRODUCTION RESULTS

METHDS§ A ten-bed acute hospice inpatient unit:

Patients are general inpatient status (GIP) for uncontrolled symptomsDelirium assessment tool non-existentDelirium inefficiently managed

§ Ten staff nurses:Attended an educational in-service on delirium, Introduced to the Nu-DESC assessment tool, and Completed a practicality survey at conclusion

95% Confidence Interval of

the Difference

Mean Std.Deviation

Std. ErrorMean

Lower Upper t df Sig. (2-tailed)

Pair 1: pre-test-post-test score

-4.800

4.614 1.459 -8.101

-1.499 -3.290 9 .009

0

5

10

15

20

25

1 2 3 4 5 6 7 8 9 10

Pre and Post Test Scores (n=10)

pre test score post test score

Question Tool Strongly Disagree

Disagree

Neither Agree or Disagree

Agree

Strongly Agree

1. I understand the concepts of the tool

Nu-DESC

0% 0% 0% 50% 50%

2. I understand the language used with the tool

Nu-DESC

0% 0% 0% 50% 50%

3. I have sufficient knowledge from my training to use the tool efficiently

Nu-DESC

0% 0% 0% 63% 38%

4. I feel confident in using these tools

Nu-DESC

0% 0% 0% 75% 25%

5. I feel the tool was quick and easy to use

Nu-DESC

0% 0% 0% 50% 50%

6. I needed extra help to use the tool

Nu-DESC

13% 63% 0% 28% 0%

7. I feel the available materials were helpful

Nu-DESC

0% 0% 0% 88% 13%

8. I feel the tool was helpful in recognizing delirium

Nu-DESC

0% 0% 25% 50% 25%

9. I feel the tool is a valuable addition to my nursing assessment skills

Nu-DESC

0% 0% 25% 50% 25%

Practicality Survey Results: 50-75% nurses agreed/strongly agreed;

§ Confidence§ Easy and Quick to Use§ Increased Recognition§ Valuable

Improve nurse’s ability to assess delirium with: education, implement delirium assessment tool