Delirium Screening and Management in Orthopedic Surgery Patients as Part of Enhanced Recovery After Surgery Implementation Rachel Anderson, Pharm. D., Jerry Robinson, Pharm.D., BCPS Huntsville Hospital - Huntsville, AL
Background/Purpose: Delirium is a common complication post-operatively in older adults, and is related to adverse outcomes including increased length of stay, morbidity, and mortality. The Enhanced Recovery After Surgery (ERAS) is an initiative with the goal of improving perioperative care for multiple surgery types, with recommendations for delirium screening and management. Currently, delirium is not routinely screened in floor patients. The primary objective is to determine which non-ICU, orthopedic surgery patients are most at risk for delirium and should be screened.
Methodology: This study is a retrospective (pre-implementation) and prospective (post-implementation) chart review. A list of patients with a hip fracture, total knee arthroplasty (TKA), or total hip arthroplasty (THA) from August to November 2018 was obtained. A patient list from medication dispensing cabinets was obtained for delirium treatment medications for cross reference with the aforementioned list. Another list of patients with an ICD-10 code for delirium and an ICD-10 code for hip fracture, TKA, or THA was also obtained. The patients that were identified as having delirium from profile review were compared to the list of patients with an ICD-10 code for delirium. Using this data, the patient population that is most at risk for delirium will be determined. After conducting education for nursing staff on delirium screening and prevention, a validated delirium screening tool and nonpharmacological methods to prevent delirium will be implemented in the identified at-risk patient population. Once this screening tool is implemented, prospective data will be collected to compare the post-implementation delirium rates in the identified at-risk patients.
Presentation Objective: Determine which non-ICU, orthopedic surgical patients are most at risk for delirium and could benefit from routine delirium screening via a validated screening tool.
Self-Assessment: Which patient population was found to be most at risk for delirium in these orthopedic surgery patients?
