Improving Nurses Knowledge of Delirium and Implementation of the R.A.D.A.R. Screening Tool at two Post Acute Care Facilities in the United States

Delirium in post acute care patients is under-recognized and linked to poor patient outcomes. Nurses in the post acute care setting are currently not using a standardized tool for assessing delirium, but the literature suggests they should do this routinely. The purposes of this study were to evaluate methods for improving the management of delirium in post acute care and to evaluate the implementation of a new screening tool for delirium (Recognizing Active Delirium As Routine or R.A.D.A.R.). This quasi-experimental study was conducted at two post acute care facilities in an urban location. The study included the implementation of a delirium education program, as well as information on the administration of the R.A.D.A. R. Delirium knowledge improvement was evaluated by comparing pre and post test scores. The post test scores were measured twice; the first time immediately after the education session, and then three months later. The results demonstrated that the nurses’ knowledge of delirium improved significantly at both post tests (p<.05). To evaluate the reliability of the nurses’ administration of the R.A.D.A. R. tool, interrater reliability was tested using Cohen’s Kappa, which found a significant level of agreement between the nursing staff and the PI (Kappa = 0.634). This pilot study found that a delirium education session can improve nurses’ knowledge of delirium and that they can maintain the knowledge gained over time. The study also identifies that the R.A.D.A. R. screening tool was administered reliably. These findings suggest that the methods utilized for this project could have implications for improving the care of the patient in the post acute care setting who is at risk for delirium. DELIRIUM IN POST ACUTE CARE 3 Improving Nurses Knowledge of Delirium and Implementation of the R.A.D.A. R. Screening Tool at two Post Acute Care Facilities in the United States Delirium, a condition occurring in geriatric patients across the continuum of healthcare, is frequently under-recognized, especially in the post acute care setting (Voyer et al., 2012). In the geriatric population, changes in mental status can be dismissed as part of aging or having dementia. However, neither of these beliefs is accurate, and each can put patients at risk for decreased quality of life and increased mortality. The incidence of delirium across practice settings varies greatly, with rates for the elderly person in an intensive care unit being as high as 87% (Saxena & Lawley, 2009). In the post acute care setting, also known as skilled nursing facility, long term care facility, and sub-acute care facility, delirium has an incidence of 34% (Arinzon, Peisakh, Schrire, & Berner, 2011). The variable incidence of delirium in different levels of care is helpful in understanding that as the severity or acuity increases, so does the risk of delirium. Delirium is associated with increased rates of mortality. For patients admitted to post acute care with delirium, the mortality rate at one year is 34% (Kiely et al., 2009). In addition to high mortality rates, delirium is also associated with significant morbidity and functional loss. Because the delirious patient is under recognized or not accurately diagnosed, this patient often requires additional and/or more complex care than is readily available in the high patient-to-staff ratio environment of many post acute care facilities (Kiely et al., 2009). A delirious patient can often require one-on-one care, which is not readily available in the post acute care setting. Across the care continuum, delirium costs are estimated at $38 billion to $152 billion per year (Leslie, Marcantonio, Zhang, Leo-Summers, & Inouye, 2008). Because of concerns about increasing health care costs combined with limited funding for Medicare and Medicaid services, DELIRIUM IN POST ACUTE CARE 4 a focus on a problem as costly as delirium would be beneficial to the health care system as a whole. Benefits could also include decreased mortality, morbidity, workload, and rehospitalizations. In geriatric patients who have delirium, their ability to return to their prior level of function or prior living situation diminishes with the diagnosis resulting in an increased financial burden. The purpose of this study is to measure the impact of education on the knowledge of delirium in the post acute care setting. Preliminary studies have validated a tool (Recognizing Active Delirium As Routine or R.A.D.A.R.) to assess for delirium in post acute care in Canada. This project evaluated two questions. The first question: Do post acute care nurses who receive education on delirium score higher on post test scores than the same nurses scored on a pretest? Secondly: Do nurses who have received education on the R.A.D.A. R. tool, administer the tool correctly in comparison to the geriatric advanced practice nurse?