Congress Abstracts 2006

41

IMPROVING RECOGNITION OF DELIRIUM IN ONCOLOGY PATIENTS: A NURSING SCREENING INITIATIVE. Gina Szymanski, MS, RN, Sharon Krumm, RN, PhD, Mikaela Olsen, RN, MS, OCN^®, and Laura Hoofring, RN, MS, Johns Hopkins Hospital, Baltimore, MD; Vicki Mock, RN, PhD, Johns Hopkins Hospital School of Nursing, 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. Cancer patients are at high risk for developing delirium. The high incidence of patient falls, increased rates of morbidity and mortality, as well as, longer and costlier hospitalizations demonstrates the importance of screening and early detection of delirium in the oncology population.

Despite the documented incidence of delirium, it is frequently missed or misdiagnosed. Results from a retrospective patient review in this designated comprehensive cancer center show similar findings. The delirium screening initiative was designed to educate the nurse and screen 100% of all patients admitted to our center.

A yearlong pilot followed by a department-wide rollout of a delirium screening initiative resulted in the documentation of the problem, established a > 25% incidence rate. The bedside nurse completes a reliable and valid screening tool based on observations of the patient throughout the shift. The screening tool is housed in our on-line documentation system, which facilitates data query. More than 2 years of data is now being analyzed to aide in the development of a delirium patient profile for our population.

Upon completion of a comprehensive education program, oncology nurses assessments to screen for delirium. The Intensive Care Delirium Screening Checklist (ICDSC) is the primary screening tool. Unit based clinical nurse specialists perform concurrent audits to monitor compliance and to analyze overall screening results. Specific outcome measures include; actual incidence of delirium, patient falls, length of stay, and the average cost of a hospital stay for a delirious patient. Patient profiling data that is analyzed in delirium positive patients includes age, length and frequency of delirium episodes, concurrent cancer treatments, co-morbidities and mortality.

This initiative will demonstrate the results of an intense delirium-screening program in an oncology population. Proper implementation across the department will require a change in practice to facilitate the diagnosis and management of this important problem. 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.