Abstract
Objective: To use a retrospective chart review to assess the time patients spent in a delirious state prior to and after the implementation of a nonpharmacologic management-of-delirium order set.|Design: Single hospital level retrospective chart review.|Setting: A medium-sized hospital located in a Midwestern city. Units included: intensive care, progressive care, telemetry, medical and surgical.|Participants: Inpatient adults who tested positive for delirium during their in-patient stay between December 15, 2016 and December 14, 2018.|Measurements: Hours spent in a delirious state were gathered as primary data from a retrospective chart review prior to and after implementation of the order set. Additional descriptive subgroup analyses utilized age, location in the hospital, and primary diagnosis. Two tools were used in the assessment of the patients' delirium status: the Richmond Agitation and Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Patients scoring positive on the RASS tool were then given the CAM-ICU tool to determine whether the patient was positive for delirium.|Results: Fifty-six patients met inclusion criteria for the first year, 16 during the second year. The mean time spent in delirium by patients prior to implementation of the order set was 56 hours (SE =7.9), while the mean hours in delirium after implementation of the order set was 25 hours (SE = 3.6); difference, - 31, 95% CI [-48, -14); p=0.001). Thus, patients in the sample collected after implementation of the order set averaged 31 hours less time in a delirious state than did patients prior to implementation of the order set.|Conclusion: This quality improvement project demonstrated a decrease in duration of recorded delirium after implementation of a non-pharmacologic order set in a midwestern hospital. This timeline coincided with the implementation of an order set using non-pharmacological approaches to treatment of delirium.