Purpose:
To describe the strategies to integrate and sustain delirium screening by staff registered nurses on admission and daily for adult patients at Mayo Clinic Rochester hospitals.
Significance:
Delirium commonly occurs in hospitalized patients and often goes unrecognized by nurses and physicians. The lack of appreciation for the significance of delirium plus the lack of using validated instruments to assess for it are obstacles to the provision of quality care.
Background/Design:
A Delirium Management Replication Team was formed to review, test, and replicate the successful processes previously implemented by a Clinical Nurse Specialist (CNS)-led specialty delirium team. Adult specialty CNSs were the initial interdisciplinary members recruited. The first task of the new team was to seek endorsement for bedside delirium screening of adult patients by staff registered nurses. The tools selected were the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the ICU (CAM-ICU).
Methods:
Team members followed the Mayo Clinic Department of Nursing Evidence-Based Nursing Practice Translational Guide for seeking endorsement for the practice change from the Department of Nursing, Nursing Clinical Practice Committee. The process includes obtaining feedback and endorsement from 10 different nursing specialty practice committees and the CNS Committee. Following endorsement, numerous traditional educational and implementation strategies were utilized including, but not limited to, CAM/CAM-ICU compliance and accuracy documentation review, the development of a nursing Web site for delirium, and a competency.
Findings:
Obtaining feedback and endorsement from key stakeholders is critical for the translation of evidence into practice. Staff nurse questions/comments are paramount in customizing implementation and the ongoing maintenance of a practice change.
Conclusions:
Delirium screening with valid and reliable tools requires multiple strategies for implementation and ongoing maintenance. Delirium screening has provided a first step to increase the recognition of delirium across hospital populations.
Implications for Practice:
CNS champions are instrumental in the integration of evidence-based nursing practice changes.