Abstract
Introduction Hospital acquired Delirium (HAD) is the third highest hospital harm within Fraser Health Authority (FHA), Vancouver, British Columbia (BC), Canada, often contributing to morbidity requiring alternative levels of care after discharge, mortality, hospital cost, chance of readmission, length of stay, and predisposition to dementia. A patient safety priority, FHA reported 1544 hospital acquired delirium cases in Fiscal Year 2021/22 for an estimated cost of $18.6 million.
In BC, 20% of our senior population are frail which can lead to reduction in function and quality of life, which is compounded by a lack of community resources to keep pace with aging population. Upstream frailty prevention is key to slow down, prevent or reverse decline enabling a return to individual’s baseline function.
Methods A prospective interventional quality improvement study was done from April 2021 until July 2023 collecting baseline Confusion Assessment Method (CAM) and Preprinted Order (PPO) utilization prior to standardizing documentation by imbedding the CAM in the nursing flowsheets and increasing access to the PPO in the hospitalist admission packs. Weekly Geriatric Education Series as well as annual Delirium Summits solidified context for these changes. The effects on both CAM and PPO utilization were then audited and visualized on annotated control charts.
Results CAM utilization showed a sustained increase from baseline of 25% in April 2021 to 100% by Dec 2022 with a corresponding jump in PPO utilization from less than 10% in April 2021 to 80% by Jan 2023 (figures 1–3). Moving the system now towards upstream Frailty prevention will thread success all the way to the community.
Conclusions Embedding changes in the infrastructure and consistent education go hand-in-hand in sustaining meaningful changes. Multimodal CAM and Frailty education with foundational Geriatric training sessions enable success in the right context.
