This is a national guideline that addresses the prevention of delirium in older adult, medical surgical patients. The first version of the guideline was published in 2009 and this current monograph represents a substantial revision of the original guideline. New areas in the guideline include a focus on delirium superimposed on pre-existing cognitive impairment, multicomponent interventions, specialized care units for older adults, and delirium prevention programs. The guideline includes a decision algorithm for nurses to use that will facilitate their recognition and treatment of deliirium
The purpose of this evidence-based practice guideline is to provide direction for identifying risk factors, conducting appropriate assessments, and implementing effective strategies for the prevention and treatment of delirium. This guideline is designed for nurses and the interprofessional health care team who provide care for elderly hospitalized patients on general medical/surgical units. Nurses play an essential role in identifying patients at risk for delirium, assessing the presence of the syndrome, intervening to prevent delirium, and working with the interprofessional team to manage the condition when it occurs. Nurses have a unique role at the bedside because of the extended patient and family interaction that occurs while providing care. Potentially, the nurse-patient relationship allows nurses to identify and monitor changes in the patient’s cognition and function over time when standardized instruments and guidelines are part of the caring process. It is important that nurses have the assessment instruments, guidance, and education to ensure effective outcomes for elders at high risk for delirium, because bed-side nurse-patient interactions alone are unreliable for detecting and preventing delirium (Mistarz, Eliott, Witfield, Ernst, 2011). Some of the recommended interventions in this guideline require physician management and interprofessional collaboration, while other interventions are effective independent nursing actions.
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