Congress Abstracts 2004

32

IT’S TIME TO STOP IGNORING DELIRIUM: AN INNOVATIVE SCREENING INITIATIVE FOR THE EARLY DETECTION AND TREATMENT OF DELIRIUM IN ONCOLOGY PATIENTS. Gina Szymanski, RN, MS, Mikaela Olsen, RN, MS, OCN^®, Sharon Krumm RN, PhD, Laura Hoofring, RN, MS, and Karin Taylor, RN, MS, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD; and Lori Paine, RN, MS, Johns Hopkins Hospital, Baltimore, MD.

Delirium is an “acute global alteration in mental state with an unidentifiable or presumed physical cause” (Moore, 1998). Delirium commonly occurs in medically ill, elderly persons with cancer, patients receiving palliative care, and the critically ill. Cancer patients are at high risk for developing delirium at various points along their treatment continuum. The high incidence of patient falls, increased rates of morbidity and mortality, as well as longer and costlier hospitalizations demonstrates the importance of early detection and treatment of delirium in the oncology population.

Despite the high documented incidence of delirium, it is frequently missed or misdiagnosed. Results from a retrospective patient review in this comprehensive cancer center show similar findings. Lack of knowledge related to delirium, its fluctuating course, and mislabeling of the problem contributes to undiagnosed delirium in the oncology population.

The aim of this quality improvement initiative is to implement a delirium screening project that enhances the current standard of care in neurologic assessment and increases the detection of this important problem in our patient population. Specific management interventions are implemented on those patients who screen positive, thus protecting patients with delirium while in the hospital environment.

Oncology nurses will conduct baseline and daily assessments to screen for delirium. Two screening tools will be utilized, the Mini-Mental Status Exam (MMSE) and the Intensive Care Delirium Screening Checklist (ICDSC). Screening results are communicated to interdisciplinary team members so that potential causes of delirium can be reviewed, and strategies for treating delirium can be initiated. The data collected by nurses in the care process, as well as administrative data, will be used to evaluate the impact of this screening initiative. Specific outcomes measures include actual incidence of delirium, patient falls, length of stay, and the average cost of a hospital stay for a delirious patient.

This initiative will demonstrate the results of intense delirium screening in an oncology population. In addition, this project will contribute to the nursing literature related to delirium in cancer patients and enhance our knowledge of this often overlooked and challenging diagnosis.