Congress Abstracts 2006

128

DON'T BE CONFUSED! ASSESSMENT OF ELDERLY SURGICAL PATIENTS' MENTAL STATUS CAN PREVENT ADVERSE EVENTS AND IMPROVE OUTCOMES. Hyacinth Gordon, RN, BSN, CRRN, MSN, OCN^®, and Joann Mick, RN, MSN, MBA, AOCN^®, CNAA, BC, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Confusion, a common condition that can develop in elderly hospitalized patients, is often overlooked or misdiagnosed. Acute confusion is characterized by sudden onset and a fluctuating course of changes in consciousness and cognition. Manifestations include: inability to focus, sustain or shift attention; disorientation; impairments in learning; and memory or language difficulties. Perceptual disturbances such as illusions, delusion and hallucinations are often present.

Research studies support a link between confusion and adverse outcomes, such as compromised recovery, increased mortality, and prolonged length of stay. Recent studies indicate that confusion occurs in as many as 61% of surgical patients. Oncology nurses must be alert to detect evidence of inattention, altered mental status, disorganized thoughts or speech, and decreased alertness.

A detailed, mental status assessment is not always included in a routine admission assessment. A retrospective review of medical records of 22 patients who became confused during their stay on our inpatient surgical oncology unit revealed that a detailed mental status assessment had not been performed. Short, reliable, easy to use tools, such as the Mini Mental State Examination and the Short Portable Mental Status Questionnaire (SPMSQ) are available for use by nurses to supplement questions on admission assessment forms. After providing education regarding instrument use, the SPMSQ was implemented as a supplemental tool to improve assessment and documentation of mental status in our surgical oncology population.

The literature supports that prompt identification and aggressive treatment of confusion in the elderly surgical patient are key factors to prevent poor outcomes. Our poster will share evaluation findings after implementation of the SPMSQ to improve assessment, early identification of symptoms of confusion, and documentation of mental status assessments on our unit.

It is critical that oncology nurses establish a baseline mental status assessment of all elderly patients admitted to the hospital. Early identification of at risk patients may provide opportunities for early intervention to prevent adverse events and improve outcomes. Additional research is needed on assessment and management of confusion in elderly patient populations.