Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Williams-Coleman, Beverly

Committee Co-Chair (if applicable)

Anderson, Debra

Author's Keywords

delirium; quality improvement; acute confusion; delirium prevention; Confusion Assessment Method


Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development.

Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of individuals with traumatic brain injuries.

Purpose: The purpose of this quality improvement project was to improve patient outcomes (decrease fall rates, decrease restraint utilization, decrease length of stay) and increase nursing knowledge, implementation and documentation of the CAM tool.

Procedures: Six ten-minute educational sessions on delirium and the use of the CAM tool were provided to nursing staff at an inpatient, long-term acute care facility in a suburban town. Retrospective chart audits were performed and the data collected included daily CAM charting compliance, CAM documentation upon admission, restraint usage, length of stay and falls rates for eight weeks prior to intervention compared to eight weeks post-intervention.

Results: Thirty-four nurses participated in the delirium education intervention. There was a statistically significant improvement in daily CAM documentation (p=

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