Screening for Delirium in Long Term Care Settings

Abstract

Background: Many of the patients who are admitted to long term care (LTC) settings, such as skilled nursing facilities (SNF), are often acutely ill, elderly, and have multiple co-morbidities. This predisposes these patients to an increased risk of developing delirium. Although delirium has been studied extensively in the acute care setting, it is not commonly studied within LTC settings. Rates of delirium in the LTC setting are as high as 70%; however, only 2.2% of cases are diagnosed. Currently, there are no screening protocols in use for detecting delirium on a SNF that is located in a metropolitan hospital in a southern state. Methods: A quality improvement project was conducted over an eight week period in the fall of 2015 in which 108 adult patients were screened using the Short Confusion Assessment Method (CAM) scale within 24 hours of admission to the SNF. Retrospective chart audits were performed for two weeks prior to implementing the Short CAM scale. This baseline data was compared to project data to determine if routine screening with the Short CAM scale is effective in identifying patients with delirium. Descriptive statistics were used to analyze project outcome data. Outcomes/Results: A total of 60 patients (n= 60) were screened during the baseline data collection period, of which only 3 patients (0.05%) were diagnosed with delirium without routine screening. Seventeen of the 108 participants (16%) who were screened during the project had a positive Short CAM scale, indicating that they were exhibiting symptoms consistent with delirium. Of the 17 positive Short CAM scales, 15 (88%) were diagnosed with delirium. Results of this project show that screening for delirium, using the Short CAM scale, increased the detection rate on the SNF. Therefore, the Short CAM scale proved to be a reliable method for detecting early cases of delirium. Keywords: delirium, long term care, skilled nursing facility, confusion assessment method, screening