Date Approved

4-4-2022

Graduate Degree Type

Dissertation

Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Sandra Spoelstra

Second Advisor

Marie VanderKooi

Third Advisor

Amy Manderscheid

Academic Year

2021/2022

Abstract

Background: Delirium is a change in consciousness characterized by rapid onset and fluctuating attention, causing impairment in the ability to process and recall information, occurring in 30% of hospitalized older adults. Delirium can increase falls, length-of-stay, mortality, and cost. The CoCare Hospital Elder Life Program® (HELP) is an evidence-based bundle of interventions targeting cognitive impairment, sleep deprivation, immobility, visual/hearing impairment, and dehydration, embedding geriatric principles in care to prevent delirium.

Objectives: To further analyze the pre-implementation of the HELP in order to optimize success of program administration.

Methods: Mixed methods were used to collect retrospective/prospective data (interviews (N=25], surveys [N=25], chart audits [N=500]) for an organization assessment from CoCare experts, the hospital, clinicians, and patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided a systematic review on implementation strategies.

Results: A high rate of falls (0.89/1000-days), length-of-stay (6.1 days), readmission rate (12.6%), restraint use (19197 hours), BEERs drugs prescribed (15.4%) and delirium (30.2%) were found. The review identified 10 strategies to guide implementation of HELP: engaging stakeholders/champions, educating staff/patients, clinical team creation/use, facilitation, auditing and feedback, examining satisfaction, and public relations. Products completed included: A University undergraduate course, Registered Nurse education, an Implementation Toolkit, clinician competency checklists, system budgeting plan, system sustainability plan, project analysis plan, recruitment fliers and Epic documentation format.

Conclusions: Use of HELP can prevent delirium. The identification of a high rate of delirium was confirmed in the hospital. The products developed will enable the hospital to implement HELP over the next year.

Implications: Delirium is prevalent among the population of interest and is associated with significant risks; however, pre-implementation of the HELP will promote a successful program launch to reduce delirium in the elderly.

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