Congress Abstracts 2005

18

THE DEVELOPMENT OF AN ALGORITHM MANAGING ACUTE DELIRIUM IN PATIENTS UNDERGOING ALLOGENIC STEM CELL TRANSPLANT (SCT). Kristine Simpson, RN, BSN, OCN^®, Keri Reardon, RN, BSN, OCN^®, and Margaret Bevans, RN, MS, AOCN^®, National Institutes of Health, Bethesda, MD.

Delirium is defined as an acute and fluctuating disruption of attention and cognition that is not accounted for by preexisting dementia. Fann et al. (2002) reports that up to 50% of recipients undergoing a SCT experience delirium. In oncology patients pre-treatment predictors have been identified as increased age, female gender, cognitive impairment, metabolic imbalances, and hematologic malignancies. SCT recipients may present with several risk factors in addition to the direct and indirect effects of their intense treatment. Negative outcomes associated with delirious behavior can include increased length of stay, and injuries related to falls or other self inflicted behaviors e.g. accidental removal of an intravascular line.

Current literature focuses on the identification of predictors and reliable recognition of delirium. Minimal information is available to guide the use of interventions to avoid negative consequences. The purpose of this project is to develop an algorithm for defining nursing intervention in SCT patients at risk for complications from delirium.

The goal of the intervention algorithm is to improve recognition, remove contributing factors and maintain patient safety and dignity. The key steps include: consistent identification of patients at risk for complications from delirium, communication of assessment with all members of the team, recognition and elimination of contributing factors, and activation of safety interventions including fall risk precautions, high observation nursing care and pharmacologic interventions.

The intervention algorithm outlines a process which assists nurses to improve communication, reduce etiological factors and create a safe environment for patients at risk for complications from delirium.

Although the multidisciplinary team participates in the development of a plan to manage delirious patients, it is frequently the nurse who identifies high risk patients, recognizes signs of delirium and activates immediate interventions to avoid harm and secondary consequences. Implementation of this standardized approach to patient care empowers the nurse to effectively reduce length of stay and morbidity in SCT recipients at risk for complications from delirium.