Delirium: Prevent, Identify, Treat

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data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/nursing-excellence/ethics/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="A-E : Ethics"> Ethics </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M"> H-M </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/health-policy/health-it/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Health IT"> Health IT </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/health-policy/health-system-reform/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Health System Transformation"> Health System Transformation </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="https://www.healthynursehealthynation.org/" target="_blank" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Healthy Nurse, Healthy Nation"> Healthy Nurse, Healthy Nation </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/work-environment/health-safety/immunize/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Immunize"> Immunize </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/workforce/improving-your-practice/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Improving Your Practice"> Improving Your Practice </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/innovation/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Innovation"> Innovation </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/innovation/events/awards/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Innovation Awards"> Innovation Awards </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/workforce/minority-fellowship-program/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="H-M : Minority Fellowship Program"> Minority Fellowship Program </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R"> N-R </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/naqc/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Nursing Alliance for Quality Care"> Nursing Alliance for Quality Care </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/nursing-excellence/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Nursing Excellence"> Nursing Excellence </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/ancc/nursing-research/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Nursing Research"> Nursing Research </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/nurse-suicide-prevention/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Nurse Suicide Prevention/Resilience"> Nurse Suicide Prevention/Resilience </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/nursing-excellence/official-position-statements/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Position Statements"> Position Statements </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/nursing-excellence/official-position-statements/ana-principles/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Principles"> Principles </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/project-firstline/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Project Firstline"> Project Firstline </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/workforce/public-health-nursing/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Public Health"> Public Health </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/health-policy/health-system-reform/quality/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Quality"> Quality </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/workforce/racism-in-nursing/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : Racism in Nursing"> Racism in Nursing </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="http://www.rnaction.org/" target="_blank" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="N-R : RN Action"> RN Action </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W"> S-W </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/work-environment/health-safety/safe-patient-handling/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Safe Patient Handling & Mobility"> Safe Patient Handling & Mobility </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/scope-of-practice/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Scope of Practice"> Scope of Practice </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/work-environment/health-safety/safe-needles/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Sharps"> Sharps </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/nurse-staffing/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Staffing"> Staffing </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/archive/practice-advocacy/telehealth/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Telehealth"> Telehealth </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/work-environment/health-safety/tobacco-free-nurses/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Tobacco Use Cessation"> Tobacco Use Cessation </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/work-environment/end-nurse-abuse/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Violence, Incivility & Bullying"> Violence, Incivility & Bullying </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/workforce/what-is-nursing/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : What is Nursing"> What is Nursing </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/work-environment/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Work Environment"> Work Environment </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/workforce/" data-primary-nav-link data-gtm-event-action="Practice & Advocacy" data-gtm-event-label="S-W : Workforce"> Workforce </a> </li> </ul> </div> </li> </ul> </div> </div> </li> <li class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="1"> <a href="/our-certifications/" class="e-nav-primary__link" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification"> <span class="e-nav-primary__link-text">Certification</span> <div class="jhtest" data-model-sectionlink="/link/7d7b5a26712c4422a0757a73ccccc020.aspx" data-model-sectionname="Certification"></div> </a> <div class="e-nav-primary__panel" data-primary-nav-tray data-primary-nav-panel> <div class="e-nav-primary__grid-constraint"> <ul class="e-nav-primary__list e-nav-primary__list--secondary"> <li class="e-nav-primary__col"> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/our-certifications/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Initial Certifications"> Initial Certifications </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/renewals/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Renewal requirements"> Renewal requirements </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/our-certifications/verification/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Verification"> Verification </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/success-pays/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Success Pays"> Success Pays </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/retired-recognition/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Retired Recognition"> Retired Recognition </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/readiness-tests/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Readiness Tests"> Readiness Tests </a> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/certification-policies/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification Policies"> Certification Policies </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/certification-policies/scores-retest-application/" data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification Policies : Scores & Retest Application"> Scores & Retest Application </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/certification-policies/expedited-review-procedure/" data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification Policies : Expedited Review Procedure"> Expedited Review Procedure </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/certification-policies/special-accommodations/" data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification Policies : Special Accommodations"> Special Accommodations </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/certification-policies/international-applicants/" data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification Policies : International Applicants"> International Applicants </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/certification-policies/" data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification Policies : See All Policies"> See All Policies </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/ANCC-content-expert-opportunities/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="ANCC Volunteer Opportunities"> ANCC Volunteer Opportunities </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/ANCC-content-expert-opportunities/current-volunteer-opportunities/" data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="ANCC Volunteer Opportunities : Current Volunteer Opportunities"> Current Volunteer Opportunities </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/education-events/ana-continuing-education/test-certification-review/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Certification Preparation"> Certification Preparation </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="https://www.prometric.com/exams/ancc" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Find a Test Center" target="_blank"> Find a Test Center </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/faqs/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="FAQs"> FAQs </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/aprn-consensus-model/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="APRN Consensus Model"> APRN Consensus Model </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="https://www.shopana.org/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="Shop ANCC Promo Items" target="_blank"> Shop ANCC Promo Items </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/certification/aprn-faculty-toolkit/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Certification" data-gtm-event-label="APRN Faculty Toolkit"> APRN Faculty Toolkit </a> </div> </li> </ul> </div> </div> </li> <li class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="1"> <a href="/advanced-practice/" class="e-nav-primary__link" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Advanced Practice"> <span class="e-nav-primary__link-text">Advanced Practice</span> <div class="jhtest" data-model-sectionlink="/link/b257bff3771746fd98e3455a59cbc001.aspx" data-model-sectionname="Advanced Practice"></div> </a> <div class="e-nav-primary__panel" data-primary-nav-tray data-primary-nav-panel> <div class="e-nav-primary__grid-constraint"> <ul class="e-nav-primary__list e-nav-primary__list--secondary"> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Professional Development"> Professional Development </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/advanced-practice/certification-verification--renewal/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Professional Development : Certification Verification & Renewal"> Certification Verification & Renewal </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/advanced-practice/2nd-certification/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Professional Development : Add an Additional Certification"> Add an Additional Certification </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Practice & Advocacy"> Practice & Advocacy </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/advanced-practice/ana-supports-aprn/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Practice & Advocacy : ANA Supports Advanced Practice"> ANA Supports Advanced Practice </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/advocacy/ana-advocacy/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Practice & Advocacy : Member-Only Resources"> Member-Only Resources </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/advocacy/state/aprn-state-law-and-regulation/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Practice & Advocacy : APRN State Law and Regulation"> APRN State Law and Regulation </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/practice-policy/scope-of-practice/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Practice & Advocacy : Scope of Practice"> Scope of Practice </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="ANA Membership"> ANA Membership </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/joinANA/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="ANA Membership : Join ANA and Your State Nurses Association"> Join ANA and Your State Nurses Association </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/my-account/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="ANA Membership : My Account"> My Account </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Certification"> Certification </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/our-certifications/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Certification : Initial Certifications"> Initial Certifications </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/our-certifications/verification/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Certification : Verification"> Verification </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/certification/renewals/" data-primary-nav-link data-gtm-event-action="Advanced Practice" data-gtm-event-label="Certification : Renewal Requirements"> Renewal Requirements </a> </li> </ul> </div> </li> </ul> </div> </div> </li> <li class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="1"> <a href="/membership/" class="e-nav-primary__link" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Membership"> <span class="e-nav-primary__link-text">Membership</span> <div class="jhtest" data-model-sectionlink="/link/ead8d35c490f438c92b06c0397cdde09.aspx" data-model-sectionname="Membership"></div> </a> <div class="e-nav-primary__panel" data-primary-nav-tray data-primary-nav-panel> <div class="e-nav-primary__grid-constraint"> <ul class="e-nav-primary__list e-nav-primary__list--secondary"> <li class="e-nav-primary__col"> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/my-account/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="My Account"> My Account </a> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/membership/member-benefits/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits"> Member Benefits </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/member-benefits/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : Member Benefits"> Member Benefits </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/member-benefits/personal-benefits/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : Personal Benefits"> Personal Benefits </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/member-benefits/premier-members/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : Premier Members"> Premier Members </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/welcome/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : New Member Welcome Center"> New Member Welcome Center </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/career-stages/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : Career Stages"> Career Stages </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/member-benefits/professional-development-resources/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : Professional Development Resources"> Professional Development Resources </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="http://community.ana.org/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : ANA Community"> ANA Community </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="https://jobs.ana.org/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Member Benefits : ANA Career Center"> ANA Career Center </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/membership/ana-periodicals/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="ANA Journals"> ANA Journals </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/membership/ana-periodicals/americannurse/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="ANA Journals : American Nurse"> American Nurse </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="http://ojin.nursingworld.org/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="ANA Journals : Online Journal of Issues in Nursing (OJIN)"> Online Journal of Issues in Nursing (OJIN) </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="http://anacapitolbeat.org/" data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="ANA Journals : Capitol Beat"> Capitol Beat </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/membership/joinANA/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Join ANA"> Join ANA </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/membership/find-my-state/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Find Your State Association"> Find Your State Association </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/membership/student-nurses/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Student Nurses"> Student Nurses </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/membership/individual-member-division-imd/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Individual Member Division"> Individual Member Division </a> </div> <div class="e-nav-primary__item " data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/ana/leadership-and-governance/membership-assembly/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Membership" data-gtm-event-label="Membership Assembly"> Membership Assembly </a> </div> </li> </ul> </div> </div> </li> <li class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="1"> <a href="/organizational-programs/" class="e-nav-primary__link" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet | Pathway | Accreditation"> <span class="e-nav-primary__link-text">Magnet | Pathway | Accreditation</span> <div class="jhtest" data-model-sectionlink="/link/d425f3fb1ebc442aad6fb641aa90c3db.aspx" data-model-sectionname="Magnet | Pathway | Accreditation"></div> </a> <div class="e-nav-primary__panel" data-primary-nav-tray data-primary-nav-panel> <div class="e-nav-primary__grid-constraint"> <ul class="e-nav-primary__list e-nav-primary__list--secondary"> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/organizational-programs/magnet/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet"> Magnet </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/ancc/awards/ancc-magnet-prize-program/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : || Magnet Prize® ||"> || Magnet Prize® || </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/ancc/awards/mnoy/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : || Magnet Nurse of the Year ||"> || Magnet Nurse of the Year || </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/about-magnet/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : About Magnet"> About Magnet </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/magnet-model/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Magnet Model"> Magnet Model </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/program-tools/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Program Tools"> Program Tools </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/journey-to-magnet-excellence/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Journey to Magnet Excellence"> Journey to Magnet Excellence </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/international/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : International"> International </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/magnet-manual-updates-and-faqs/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Magnet Application Manual Updates and FAQs"> Magnet Application Manual Updates and FAQs </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/apply/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Apply"> Apply </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/public-comment/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Public Comment"> Public Comment </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/globalassets/organizational-programs/magnet/imr/interim-report-imr.pdf" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Interim Monitoring Requirements"> Interim Monitoring Requirements </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/find-a-magnet-organization/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Find a Magnet Organization"> Find a Magnet Organization </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/new-magnet-organizations/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : New/Redesignated Organizations"> New/Redesignated Organizations </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/adamplus/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : ADAM/ADAMplus"> ADAM/ADAMplus </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/magnet/contact-magnet-staff/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Magnet : Contact Magnet Staff"> Contact Magnet Staff </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/organizational-programs/pathway/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway"> Pathway </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/overview/pathway-award/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : || Pathway Award ||"> || Pathway Award || </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/overview/pathway-nurse-of-the-year-award/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : || Pathway Nurse of the Year Award ||"> || Pathway Nurse of the Year Award || </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/overview/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : Overview"> Overview </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/overview/the-application-process/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : Before You Apply"> Before You Apply </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/apply/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : Apply"> Apply </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/pte-renewal/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : Pathway Redesignation"> Pathway Redesignation </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/find-a-pathway-organization/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : Find A Pathway Organization"> Find A Pathway Organization </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/pathway/new-pathway-organizations/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : New Pathway Organizations"> New Pathway Organizations </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="http://www.pathwaylearningcommunity.org/home" target="_blank" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : Pathway Learning Community"> Pathway Learning Community </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/continuing-education/ce-subcategories/pathway/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Pathway : Publications and Products"> Publications and Products </a> </li> </ul> </div> </li> <li class="e-nav-primary__col"> <div class="e-nav-primary__item e-nav-primary__item--has-children" data-primary-nav-item data-nav-level="2"> <a class="e-nav-primary__link e-nav-primary__link--arrow" href="/organizational-programs/accreditation/" data-primary-nav-trigger data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Accreditation"> Accreditation </a> <ul class="e-nav-primary__list e-nav-primary__list--tertiary" data-primary-nav-tray> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/accreditation/ncpd/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Accreditation : Nursing Continuing Professional Development"> Nursing Continuing Professional Development </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="http://www.jointaccreditation.org/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Accreditation : Joint Accreditation"> Joint Accreditation </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/accreditation/appfa/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Accreditation : Advanced Practice Provider Fellowship Accreditation™ (APPFA)"> Advanced Practice Provider Fellowship Accreditation™ (APPFA) </a> </li> <li class="e-nav-primary__item" data-primary-nav-item data-nav-level="3"> <a class="e-nav-primary__link" href="/organizational-programs/accreditation/ptap/" data-primary-nav-link data-gtm-event-action="Magnet | Pathway | Accreditation" data-gtm-event-label="Accreditation : Practice Transition Accreditation Program"> Practice Transition Accreditation Program </a> </li> <li class="e-nav-primary__item" data-primary-nav-item 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class="grid"> <div class="grid__item one-whole large--two-thirds pad--large--one-third"> <h1 class="t-type-h2" >Delirium: Prevent, Identify, Treat</h1> </div> <div class="grid__item one-whole large--one-quarter zero-height"> <nav class="c-subnav" data-require="./src/views/sub-nav-view"> <a href="#" class="c-subnav__open" data-show-subnav>Pages in this section</a> <div class="c-subnav__wrap" data-subnav-wrap> <h2 class="c-subnav__heading"> <a class="c-subnav__heading-link" href="/practice-policy/" target="">Practice & Advocacy</a> </h2> <ul class="c-subnav__list c-subnav__list--lv1"> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/nursing-excellence/" class="c-subnav__link" target=""> Nursing Excellence </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/nurse-staffing/" class="c-subnav__link" target=""> Nurse Staffing </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/work-environment/" 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class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/workforce/" class="c-subnav__link" target=""> Workforce </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/hnhn/" class="c-subnav__link" target=""> Healthy Nurse </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/aprn/" class="c-subnav__link" target=""> APRN </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/scope-of-practice/" class="c-subnav__link" target=""> Scope of Practice </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/community-paramedics/" class="c-subnav__link" target=""> Community Paramedics </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/state-law-and-regulation/" class="c-subnav__link" target=""> State Law and Regulation </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/barriers-to-rn-scope-of-practice-panel/" class="c-subnav__link" target=""> Barriers to RN Scope of Practice Panel </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/medication-aides--assistants--technicians/" class="c-subnav__link" target=""> Medication Aides, Assistants, Technicians </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/naqc/" class="c-subnav__link" target=""> NAQC </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/project-firstline/" class="c-subnav__link" target=""> Project Firstline </a> </li> <li class="c-subnav__item c-subnav__item--lv1"> <a href="/practice-policy/innovation/" class="c-subnav__link" target=""> Innovation </a> </li> </ul> </div> </nav> </div> <div class="grid__item one-whole large--two-thirds pad--large--one-third"> <div class="e-richtext"> <p>A joint and interdisciplinary collaboration between the American Nurses Association and the American Delirium Society</p> <p>Delirium is an acute, serious, and often preventable, medical condition characterized by confusion and a disturbed thought process, often following assault to the body such as surgery, infection, dehydration, or certain medications. Delirium affects large numbers of patients across all healthcare settings, including children, by negatively impacting patient outcomes, causing family caregiver distress and increasing financial costs.</p> <h4>Did you know delirium is common, serious, and often preventable?</h4> <p>Common</p> <ul> <li>Delirium occurs in up to 25% hospitalized patients, 50% of surgical patients, 20% of nursing home patients, 77% of burn patients and 75% of ICU patients.<span>1, 2</span></li> <li>An estimated 37% of surgical patients experience postoperative delirium.<span>3</span></li> <li>Delirium may be higher in patients 70 years of age or older.<span>3</span></li> <li>Delirium occurs in up to 50% of patients with dementia that require hospitalization.<span>4</span></li> </ul> <p>Serious</p> <ul> <li>Delirium is associated with many adverse outcomes which include: increased mortality, falls, functional decline, cognitive impairment and decline and significant costs.<span>5</span></li> <li>Delirium superimposed on dementia may accelerate the trajectory of decline and often results in long lengths of stay, readmissions, premature nursing home placement or death.<span>4</span></li> <li>Delirium is a major financial burden to medical services and costs range from $38 to $152 billion per year.<span>3</span></li> </ul> <p>Preventable</p> <ul> <li>Since frontline nurses are in direct contact with patients 24 hours per day and seven days a week, RNs need to drive delirium prevention. The best prevention protocol simply consists of high-level nursing care.<span>6</span></li> </ul> <p> </p> </div> <div class="dynamic-ad-container dynamic-ad-container-leaderboard"> <div id="ROS-728" class="dynamic-ad dynamic-ad-leaderboard" style="margin: 20px auto; height: 90px; width: 728px;"> <script type="text/javascript"> // <![CDATA[ googletag.cmd.push(function() { googletag.display('ROS-728'); }); // ]]></script> </div> </div> </div> </div> </div> <div class="content-area"><div class="block c-container-block"><div class="grid-constraint"><div class="grid"><div class="c-container-block__content"><div class="block accordionitemblock grid__item one-whole large--two-thirds pad--large--one-third hasnav"> <section class="e-accordion__item" data-require="./src/views/accordion-item-view" data-collapse-panel="true" data-gtm-event-action="/practice-policy/work-environment/health-safety/delirium/" data-gtm-event-label="Who We Are" > <a class="e-accordion__toggle" href="#" data-accordion-toggle> <h2 class="e-accordion__toggle-title">Who We Are</h2> </a> <div class="e-accordion__item-content" data-accordion-content> <div class="e-richtext"> <p><strong>American Nurses Association/American Delirium Society Steering Committee Members</strong></p> <p>Mary Jo Assi, CO-CHAIR • Marianne Shaughnessy, CO-CHAIR</p> <p>Rakesh Arora • John Devlin • Donna Marie Fick • Joseph Flaherty • Sharon Gordon • Babar Khan • Ann Marie Kolanowski • Jose Maldonado • Karin Neufeld • Pratik Pandharipande • Joyce Parks • James Rudolph • Heidi Smith • Yibing Tan • Christine Waszynski • Megan Wheeler<br /> </p> <p><strong>American Nurses Association Delirium Work Group Members</strong></p> <p>Claudia Smith, CHAIR</p> <p><span>Mary Jo Assi • Stewart Bond • Edward Briggs • Matt Brown • Holly Carpenter • Mary Kate Eanniello • Petra Grami • Cheryl Haseeb • Laura Hoofring • Ruth Ludwick • Sheila Molony • Donal Palencia • Joyce Parks • Padmini Paul • Hannah Noori • Stacey Williams • Andrea Yevchak • Margarete Zalon</span></p> </div> </div> </section></div><div class="block accordionitemblock grid__item one-whole large--two-thirds pad--large--one-third hasnav"> <section class="e-accordion__item" data-require="./src/views/accordion-item-view" data-collapse-panel="true" data-gtm-event-action="/practice-policy/work-environment/health-safety/delirium/" data-gtm-event-label="Introduction" > <a class="e-accordion__toggle" href="#" data-accordion-toggle> <h2 class="e-accordion__toggle-title">Introduction</h2> </a> <div class="e-accordion__item-content" data-accordion-content> <div class="e-richtext"> <p>Proper clinical identification of delirium and quick use of personalized evidence-based interventions is the hallmark of treatment. Failure to identify and treat can result in increased costs but even more importantly, poor patient outcomes and subsequent decreased quality of life.</p> <p>Failure to or delay in identifying delirium is common in healthcare. To compound the issue of delayed diagnosis and lack of early intervention, healthcare providers, including nurses, often contribute to the incidence of delirium by administering treatments and medications that can cause this serious condition. During the last several years there has been a notable increase in research focused on evidence-based prevention, identification, and treatment of delirium. The bedside nurse is in a unique position to make a clinical difference for these vulnerable patients by using a systematic approach.</p> <p>Delirium is a condition that can be marked by fluctuating levels of consciousness with inattention as the key feature and can be a mix of the hypoactive and hyperactive types. It is well established that delirium's adverse consequences include functional decline <sup>1</sup>, increased likelihood of falls<sup>2</sup>,<sup>3</sup>, (3) longer hospital length of stay<sup>3</sup>, (4) hospital readmissions<sup>4</sup>, (5) greater likelihood of nursing home placement<sup>1</sup>,<sup>5</sup>, (6) increased risk for subsequent development of dementia or cognitive impairment<sup>6</sup>, and (7) higher morbidity and mortality<sup>7</sup>. Evidence-based management of delirium requires an individualized, multi-component approach. An interdisciplinary approach to prevent, manage, and treat delirium is essential. This website has been created for the practitioner to be able to access high quality, evidence-based resources. It is our hope that the user will apply this information to improve the quality of care and the quality of life of those affected.</p> <h4>References:</h4> <p><sup>1</sup> Dasgupta, M., & Brymer, C. (2014). Prognosis of delirium in hospitalized elderly: Worse than we thought. <em>International Journal of Geriatric Psychiatry, 29</em>(5), 497-505. doi: 10.1002/gps.4032.</p> <p><sup>2</sup> Lakatos, B. E., Capasso, V., Mitchell, M. T., Kilroy, S. M., Lussier-Cushing, M., Sumner, L., Repper-Delisi, J., Kelleher, E. P., Delisle, L. A., Cruz, C., & Stern, T. A. (2009). Falls in the general hospital: Association with delirium, advanced age, and specific surgical procedures. <em>Psychosomatics, 50</em>(3), 218-226. doi: 10.1176/appi.psy.50.3.218.</p> <p><sup>3</sup> Mangusan, R. F., Hooper, V., Denslow, S. A. & Travis, L. (2015). Outcomes associated with postoperative delirium after cardiac surgery. American Journal of Critical Care, 24(2), 156-163. doi: 10.4037/ajcc2015137.</p> <p><sup>4</sup> Koster, S., Hensons, A. G. Schuurmans, M. J., & van der Palen, J. (2012). Consequences of delirium after cardiac operations. Annals of Thoracic Surgery, 93(3), 705-711. doi: 10.1016/j.athoracsur.2011.07.006.</p> <p><sup>5</sup> Krogseth, M., Wyller, T. B., Engedal, K. & Juliebø, V. (2014). Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients. Journal of Psychosomatic Research, 76(1), 68-74. doi: 10.1016/j.jpsychores.2013.10.006.</p> <p><sup>6</sup> Krogseth, M., Watne, L. O., Juliebø, V., Skovlund, E., Engedal, K., Frihagen, F. & Wyller, T. B. (2016). Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients. Archives of Gerontology and Geriatrics, 64, 38-44. doi: 10.1016/j.archger.2015.12.004.</p> <p><sup>7</sup> Pauley, E., Lishmanov, A., Schumann, S., Gala, G. J., van Diepen, S. & Katz, J. N. (2015). Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit. American Heart Journal, 170(1), 79-86, 86e1. doi: 10.1016/j.ahj.2015.04.013.<br /> </p> <h4>Landing Page “Did You Know” Statistics References:</h4> <p><sup>1</sup> Rudolph, J. L., Archambault, E., Kelly, B. & VA Boston Delirium Task Force. (2014). A delirium risk modification program is associated with hospital outcomes. Journal of American Medical Directors Association, 15(12), 957e7-957e11.</p> <p><sup>2</sup> Agarwal, V., O’Neil, P. J., Cotton, B. A., Pun, B. T., Haney, S., Thompson, J., Kassebaum, N., Shintani, A., Guy, J., Ely, E. W., & Pandharipande, P. (2010). Prevalence and risk factors for development of delirium in burn intensive care unit patients. Journal of Burn Care and Research, 31(5), 706-15. doi: 10.1097/BCR.0b013e3181eebee9.</p> <p><sup>3</sup> Zhang, H., Lu, Y., Liu, M., Zou, Z., Wang, L., Xu, F. Y., & Shi, X. Y. (2013). Strategies for prevention of postoperative delirium: A systematic review and meta-analysis of randomized trials. Critical Care, 17(2), 1-21.</p> <p><sup>4</sup> Kolanowski, A., Fick, D., Clare L., Therrien, B., & Gill, D. (2010). An intervention for delirium superimposed on dementia based on cognitive reserve. Aging & Mental Health, 14(2), 232-242. doi: 101080/136907860903167853</p> <p><sup>5</sup> Martinez, F., Tobar, C., & Hill, N. (2015). Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age and Ageing, 44(2), 196-204. doi: 101093/ageing/aful73</p> <p><sup>6</sup> Rivosecchi, R. M., Smithburger, P. L., Svec, S., Campbell, S., & Kane-Gill, S. L. (2015). Non-pharmacological interventions to prevent delirium: An evidence-based systematic review. Critical Care Nurse, 35(1), 39-51.</p> </div> </div> </section></div><div class="block linklistblock grid__item one-whole large--two-thirds pad--large--one-third hasnav"> <section class="c-in-page-link-list"> <h2 class="e-link-list__heading"> Delirium Primer </h2> <ul class="c-in-page-link-list__list"> <li class="e-download-cta__item"> <a href="/globalassets/practiceandpolicy/innovation--evidence/deliriumprimer20160517rev2.pdf" class="e-download-cta" target="_blank" label="Delirium: A Nurse's Primer"> <div class="e-download-cta__content"> <div class="e-download-cta__heading">Delirium: A Nurse's Primer</div> <span class="e-download-cta__file-type">pdf (0.89MB)</span> <span class="e-icon-list__item e-icon-list__item--icon-file-pdf icon icon--icon-file-pdf e-download-cta__file-icon"></span> </div> </a> </li> </ul> </section> </div><div class="block accordionitemblock grid__item one-whole large--two-thirds pad--large--one-third hasnav"> <section class="e-accordion__item" data-require="./src/views/accordion-item-view" data-collapse-panel="true" data-gtm-event-action="/practice-policy/work-environment/health-safety/delirium/" data-gtm-event-label="Select Delirium Resources" > <a class="e-accordion__toggle" href="#" data-accordion-toggle> <h2 class="e-accordion__toggle-title">Select Delirium Resources</h2> </a> <div class="e-accordion__item-content" data-accordion-content> <div class="e-richtext"> <p><span style="font-size: small;">For a comprehensive overview of delirium as well as multiple resources, please visit the American Delirium Society’s website:<a href="https://www.americandeliriumsociety.org/" target="_blank" rel="noopener">https://www.americandeliriumsociety.org/</a></span><br /> </p> <table class="e-responsive-table" border="0"> <thead> <tr> <td valign="top"> <p><strong>Media Type</strong></p> </td> <td valign="top"> <p><strong>Year</strong></p> </td> <td valign="top"> <p><strong>Name</strong></p> </td> <td valign="top"> <p><strong>Webpage</strong></p> </td> <td valign="top"> <p><strong>Description</strong></p> </td> </tr> </thead> <tbody> <tr> <td colspan="5" valign="top"> <p><strong><em>Family Education</em></strong></p> </td> </tr> <tr> <td valign="top"> <p><strong>Family Education</strong></p> <p><strong>Professional Education</strong></p> <p>💻 Website<br />👓 Article/Book</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>Australian Delirium Association</p> <p>Healthcare Professionals</p> </td> <td valign="top"> <p>http://delirium.<br />org.au/</p> </td> <td valign="top"> <p>Website for community and healthcare professionals with information on delirium</p> <ul> <li>Bi-annual Newsletter (Events/Updates)</li> <li>Delirium facts, definition, risk factors/causes, prevention, early identification, accurate diagnosis, management and impact</li> <li>Links to other websites for delirium education</li> <li>Journal Articles and Reviews</li> </ul> </td> </tr> <tr> <td valign="top"> <p><strong>Family Education</strong></p> <p><strong>Professional Education</strong></p> <p>💻 Website<br />📄 Handouts<br />☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>ICU-Delirium and Cognitive Impairment Study Group</p> </td> <td valign="top"> <p><a href="http://www.icudelirium.org/" target="_blank" rel="noopener">http://www.icu<br />delirium.org/</a></p> <p><a href="http://www.icudelirium.org/patients.html" target="_blank" rel="noopener">http://www.icu<br />delirium.org/<br />patients.html</a></p> </td> <td valign="top"> <p>ICU Delirium and Cognitive Impairment Study Group: Vanderbilt University, Monroe Carell Jr. Children’s Hospital at Vanderbilt, & US Dept of Veteran Affairs (VA). Website for healthcare professionals and family about delirium, which includes patients of all ages and populations</p> <ul> <li>Delirium facts, terminology and learning mnemonics</li> <li>ABCDEF Bundle for delirium prevention</li> <li>Assessment</li> <li>Patient testimonials</li> <li>References/Research Studies/Articles</li> <li>Learning tools for healthcare professionals/Videos/Handouts/Charts</li> <li>Learning Tools for families/Brochures/Videos/Handouts</li> </ul> </td> </tr> <tr> <td valign="top"> <p><strong>Family Education</strong></p> <p>📄 Handouts</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>Delirium</p> </td> <td valign="top"> <p><a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__www.upmc.com_patients-2Dvisitors_education_behavioral-2Dhealth_pages_delirium.aspx&d=BQMGaQ&c=B4R_ht7WXlUcju8vSt5CqEvD6y3IOyws5b2PAPMjxz4&r=o-p3sGN6fevdANDVuY5Q4YUGcjUJ3WANy0i3P10RZGw&m=dz1qiLpsAqzDPK6eBbs0ds1KfaQNs44lO1WIXyGHr_w&s=3is__kn-SmwydEVYnL28Gzn6C3_KPkmT3pF8POW6JlI&e=" target="_blank" rel="noopener">http://www.<br />upmc.com/<br />patients-visitors/<br />education/<br />behavioral-<br />health/pages/<br />delirium.aspx</a></p> </td> <td valign="top"> <p>University of Pennsylvania Medical Center patient and family delirium education information page on delirium.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Family Education</strong></p> <p>☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2012</p> </td> <td valign="top"> <p>Dept. of VA</p> <p>Delirium Quiet & Excited</p> </td> <td valign="top"> <p><a href="https://www.youtube.com/watch?v=M4wsPTtGeIc" target="_blank" rel="noopener">https://www.<br />youtube.com/<br />watch?v=<br />M4wsPTtGeIc</a></p> </td> <td valign="top"> <p>Barbara Kamholz, MD developed the video, as a federal employee, to assist those who care for persons in delirium. This video helps families understand the beginning of delirium and its intervention.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Family Education</strong></p> </td> <td valign="top"> <p>2010</p> </td> <td valign="top"> <p>In the Intensive Care Unit Delirium</p> </td> <td valign="top"> <p><a href="http://www.icudelirium.org/docs/delirium_education_brochure.pdf" target="_blank" rel="noopener">http://www.icu<br />delirium.org/<br />docs/delirium_<br />education_<br />brochure.pdf</a></p> </td> <td valign="top"> <p>ICU Delirium & Cognitive Impairment Study Group. Educational brochure for family members of patients who experience delirium.</p> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>General Education</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p><strong>Professional Education</strong></p> <p>☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>Delirium: Hidden Dangers and Beyond</p> </td> <td valign="top"> <p><a href="https://www.youtube.com/watch?v=r6mgBwiz6yE" target="_blank" rel="noopener">https://www.<br />youtube.com/<br />watch?v=<br />r6mgBwiz6yE</a></p> </td> <td valign="top"> <p>American Association of Critical Care Nurses, Houston Gulf Coast Chapter created an educational video to raise delirium awareness and provide an introduction to the Grami-Smith Delirium Prevention Bundle© as a delirium prevention strategy.</p> <p>Target Audience: All<br />Time: 12.08 minutes.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Professional Education</strong></p> <p>💻 Website</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>iDelirium</p> </td> <td valign="top"> <p>http://www.<br />idelirium.org/</p> </td> <td valign="top"> <p>iDelirium is a collaboration of three delirium organizations working with patients, caregivers, professionals, and policymakers to promote delirium science.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Professional Education</strong></p> <p>💻 Website<br />👓 Article/Book</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>American Association of Critical-Care Nurses</p> <p>Delirium Assessment and Management</p> </td> <td valign="top"> <p><a href="http://www.aacn.org/" target="_blank" rel="noopener">www.aacn.org</a></p> <p><a href="http://www.aacn.org/wd/practice/content/practicealerts/delirium-practice-alert.pcms?menu=practice" target="_blank" rel="noopener">http://www.<br />aacn.org/wd/<br />practice/content/<br />practicealerts/<br />delirium-<br />practice-<br />alert.pcms?<br />menu=practice</a></p> </td> <td valign="top"> <p>Website for healthcare professionals about delirium in patients of all ages and populations</p> <ul> <li>References, research studies, articles</li> <li>Practice guidelines and Best Practice Alerts</li> </ul> </td> </tr> <tr> <td valign="top"> <p><strong>Professional Education</strong></p> <p>💻 Website</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>European Delirium Association</p> </td> <td valign="top"> <p><a href="http://www.europeandeliriumassociation.org/" target="_blank" rel="noopener">http://www.<br />european<br />delirium<br />association.org/</a></p> </td> <td valign="top"> <p>Website for healthcare professionals and other interested parties on delirium. Includes videos and other resources.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Professional Education</strong></p> <p>💻 Website<br />📄 Handouts<br />☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>ICU Delirium and Cognitive Impairment Study Group</p> </td> <td valign="top"> <p><a href="http://www.icudelirium.org/resources.html" target="_blank" rel="noopener">www.icudelirium<br />.org/resources.<br />html</a></p> </td> <td valign="top"> <p>Webpage of resources for healthcare professionals related to screening and assessment of delirium, and management using The ABCDEF Bundle. Webpage includes a variety of education slides in addition to other materials.</p> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>Social Media</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p><strong><em>Professional Education</em></strong></p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>American Delirium Society Facebook</p> </td> <td valign="top"> <p><a href="https://www.facebook.com/theamericandeliriumsociety" target="_blank" rel="noopener">https://www.<br />facebook.com/<br />theamerican<br />deliriumsociety</a></p> </td> <td valign="top"> </td> </tr> <tr> <td valign="top"> <p><strong><em>Professional Education</em></strong></p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>American Delirium Society Twitter</p> </td> <td valign="top"> <p>@AmerDelirium</p> </td> <td valign="top"> </td> </tr> <tr> <td valign="top"> <p><strong><em>Professional Education</em></strong></p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>Delirium Care Network Twitter</p> </td> <td valign="top"> <p>@DeliriumCare</p> </td> <td valign="top"> </td> </tr> <tr> <td valign="top"> <p><strong><em>Professional Education</em></strong></p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>European Delirium Association Facebook</p> </td> <td valign="top"> <p><a href="https://www.facebook.com/EDA.delirium/?fref=ts" target="_blank" rel="noopener">https://www.<br />facebook.com/<br />EDA.delirium/<br />?fref=ts</a></p> </td> <td valign="top"> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>Palliative Care</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p><strong>Professional Education</strong></p> <p>☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2011</p> </td> <td valign="top"> <p>Delirium – presentation, issues and management in Palliative Care</p> </td> <td valign="top"> <p><a href="https://www.youtube.com/watch?v=pkVia_NIc-k" target="_blank" rel="noopener">https://www.<br />youtube.com/<br />watch?v=pkVia<br />_NIc-k</a></p> </td> <td valign="top"> <p>Uploaded on April 3, 2011.</p> <p>Dr. Ted Braun, Alberta Health Services, provided the plenary at the annual conference of the Saskatchewan Hospice Palliative Care Association (SHPCA). The one-hour video addresses delirium in the home health and inpatient settings for the palliative care population. It includes case study reviews, subtypes of delirium, signs and symptoms, delirium assessment tools, and delirium management suggestions.</p> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>Older Adults</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p><strong><em>Professional Education</em></strong></p> <p>☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2012</p> </td> <td valign="top"> <p>Dept. of VA, Geriatric Research Education & Clinical Centers (GRECC)</p> <p>Agitated Behaviors Among Older Hospitalized Patients</p> </td> <td valign="top"> <p><a href="https://www.youtube.com/watch?v=GrJypBgHUxk" target="_blank" rel="noopener">https://www.<br />youtube.com/<br />watch?v=<br />GrJypBgHUxk</a></p> </td> <td valign="top"> <p>This video includes common vignettes of older hospitalized patients who appear agitated. For each vignette, viewers will see how staff try to handle the situation, first in a traditional way which is not very effective; then, in a more successful way that demonstrates the T-A-DA method (Tolerate, Anticipate, Don't Agitate).</p> </td> </tr> <tr> <td valign="top"> <p><strong><em>Professional Education</em></strong></p> <p>☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2012</p> </td> <td valign="top"> <p>Dept. of VA, GRECC</p> <p>Agitated Behaviors Among Older Nursing Home Residents</p> </td> <td valign="top"> <p><a href="https://www.youtube.com/watch?v=iORtNxwMK6o" target="_blank" rel="noopener">https://www.<br />youtube.com/<br />watch?v=<br />iORtNxwMK6o</a></p> </td> <td valign="top"> <p>This video includes common vignettes of older patients living in a nursing home who either become agitated or are agitated. For each vignette, viewers will see how staff try to handle the situation, first in a traditional way which is not very effective; then, in a more successful way that demonstrates the T-A-DA method (Tolerate, Anticipate, Don't Agitate).</p> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>Pediatric Assessment Tools</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p>💻 Website</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>ICU Delirium and Cognitive Impairment Study Group</p> <p>pCAM-ICU</p> </td> <td valign="top"> <p><a href="http://www.icudelirium.org/pediatric.html" target="_blank" rel="noopener">http://www.icu<br />delirium.org/<br />pediatric.html</a></p> </td> <td valign="top"> <p>The pCAM-ICU was adapted from the Confusion Method for the ICU (CAM-ICU) for use in intubated or non-intubated children who are at least 5 years of age and who do not demonstrate significant developmental delay. The webpage provides pocket cards for delirium monitoring using the pCAM-ICU and either the RASS or SBS on the webpage.</p> </td> </tr> <tr> <td valign="top"> <p>💻 Website</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>ICU Delirium and Cognitive Impairment Study Group</p> <p>psCAM-ICU</p> </td> <td valign="top"> <p><a href="http://www.icudelirium.org/pediatric.html" target="_blank" rel="noopener">http://www.icu<br />delirium.org/<br />pediatric.html</a></p> </td> <td valign="top"> <p>Recently developed delirium assessment tool which is used in infants at least 6 months of age. Validation studies are in progress. Patients may be critically ill, intubated or non-intubated.</p> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>Adult Assessment Tools</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p>💻 Website</p> </td> <td valign="top"> <p>2015</p> </td> <td valign="top"> <p>American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults</p> </td> <td valign="top"> <p>https://www.<br />guideline.gov/<br />summaries/<br />summary/49933</p> </td> <td valign="top"> <p>List of drugs that may be inappropriate for use in older adults including the rationale, recommendation, quality of the evidence, and the strength of the recommendation.</p> </td> </tr> <tr> <td valign="top"> <p>☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>ConsultGeri</p> </td> <td valign="top"> <p><a href="https://consultgeri.org/" target="_blank" rel="noopener">https://consult<br />geri.org/</a></p> </td> <td valign="top"> <p>A clinical website of The Hartford Institute for Geriatric Nursing. Classic assessment tools commonly used in the geriatric population. Includes delirium screening tools and links as well as sections dedicated to specialty nursing and/or caring for persons with dementia.</p> </td> </tr> <tr> <td valign="top"> <p>👓 Article/Book<br />☉ CD/DVD/     Video</p> </td> <td valign="top"> <p>2011</p> </td> <td valign="top"> <p>Delirium: The under-recognized medical emergency “How to Try This” Video.</p> </td> <td valign="top"> <p><a href="http://journals.lww.com/ajnonline/Fulltext/2007/12000/How_to_Try_This__Detecting_Delirium.27.aspx" target="_blank" rel="noopener">http://journals.<br />lww.com/<br />ajnonline/<br />Fulltext/2007/<br />12000/How_to_<br />Try_This__<br />Detecting_<br />Delirium.<br />27.aspx</a></p> </td> <td valign="top"> <p>American Journal of Nursing. Provides access to article and training video. This video guides viewers through the utilization of two tools: the Confusion Assessment Method (CAM) and Assessing and Managing Delirium in Older Adults with Dementia. In this five chapter program, two patients are presented and assessed for delirium using the CAM: one with delirium and one with a delirium superimposed on an underlying dementia. Once identified, further assessment and treatment of the underlying etiology and safe management of care is shown using the Delirium Superimposed on Dementia Algorithm.</p> <p>Time: 51.19 minutes.</p> </td> </tr> <tr> <td valign="top"> <p>👓 Article/Book</p> </td> <td valign="top"> <p>Rev. 2012</p> </td> <td valign="top"> <p>The Geriatric Depression Scale (GDS)</p> </td> <td valign="top"> <p><a href="https://consultgeri.org/try-this/general-assessment/issue-4.pdf" target="_blank" rel="noopener">https://consult<br />geri.org<br />/try-this<br />/general-<br />assessment/<br />issue-4.pdf</a></p> </td> <td valign="top"> <p>From the Hartford Institute for Geriatric Nursing, New York University College of Nursing, this article outlines the strengths, limitations, and validity and reliability of the GDS, as well as its target population. It also includes the short form of the GDS.</p> </td> </tr> <tr> <td valign="top"> <p>👓 Article/Book<br />💻 Website</p> </td> <td valign="top"> </td> <td valign="top"> <p>Nursing Home Toolkit</p> </td> <td valign="top"> <p><a href="http://www.nursinghometoolkit.com/" target="_blank" rel="noopener">www.nursing<br />hometoolkit.<br />com</a></p> </td> <td valign="top"> <p>Prepared for the Commonwealth Fund in collaboration with The John A. Hartford Foundation with A. Kolanowski & K. Van Haitsma as expert panel coordinators. Nursing Home Toolkit focuses on behavioral health of nursing home residents, although the information is pertinent to hospitalized patients as well. Primary focus of webpage is dementia. A small amount of information about delirium is found under the heading, Toolkit. In the Assessment section, pay particular attention to the NOTE in the middle of the page and the two citations listed. In the heading, Urgent and Unresolved Behaviors, explore the section, Managing Specific Behaviors. In the second row of topics explore the topic, Delirium /Acute Confusion.</p> </td> </tr> <tr> <td valign="top"> <p>☉ CD/DVD/     Video<br />📄 Handouts<br />💻 Website</p> </td> <td valign="top"> <p>2014</p> </td> <td valign="top"> <p>RADAR Training materials, poster, research results, videos, and validation results</p> </td> <td valign="top"> <p>http://radar.<br />fsi.ulaval.ca/<br />?page_id=54</p> </td> <td valign="top"> <p>Phillip Voyeur et al. The first presentation focuses on the proper use of the R.A.D.A.R. delirium assessment tool. The presentation focuses on the proper use of the RADAR delirium assessment tool for nurses. Effectively uses cases studies as teaching tools. Does not include information about scoring the results.</p> <p>Time: 26:28 minutes.</p> <p>Definitions of different types of delirium that are found in the DSM are discussed. The second video presents validation statistics of the RADAR tool, which is intended for nurses to assess patients for delirium.</p> <p>Time: 20:47 minutes.</p> </td> </tr> <tr> <td valign="top"> <p>👓 Article/Book</p> </td> <td valign="top"> <p>2015</p> </td> <td valign="top"> <p>American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th | DSM-5</p> </td> <td valign="top"> <p><a href="http://dsm.psychiatryonline.org/" target="_blank" rel="noopener">dsm.psychiatry<br />online.org</a></p> </td> <td valign="top"> <p>The DSM-5 is a resource for all healthcare professionals. It is a resource with current information to help guide clinical practice in the treatment of mental health issues in various healthcare settings. Delirium diagnosis and management is discussed. Links to numerous articles and research studies on delirium.</p> </td> </tr> <tr> <td valign="top"> <p>📄 Handouts<br />☉ CD/DVD/     Video<br />💻 Website</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>Adult Non-ICU Care: Monitoring Delirium</p> </td> <td valign="top"> <p><a href="http://www.icudelirium.org/non-icu.html" target="_blank" rel="noopener">http://www.icu<br />delirium.org/<br />non-icu.html</a></p> </td> <td valign="top"> <p>The ICU Delirium and Cognitive Impairment Study Group provides a rich source of delirium assessment tools for use in hospital areas outside of the ICU. The following tools are highlighted: The Delirium Triage Screen (DTS); The Brief Confusion Assessment Method (bCAM); The Confusion Assessment Method (CAM); The 3D CAM for elders takes approximately 3 minutes; and the 4 ‘A’s Test (4AT), which is used commonly internationally and takes approximately 2 minutes to complete. Instructions, flow sheets, articles, and links are located on the webpage.</p> </td> </tr> <tr> <td valign="top"> <p>💻 Website<br />📄 Handouts<br />👓 Article/Book</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>4AT</p> </td> <td valign="top"> <p><a href="http://www.the4at.com/" target="_blank" rel="noopener">http://www.<br />the4at.com/</a></p> </td> <td valign="top"> <p>This validated tool was designed for the rapid assessment of delirium and cognitive impairment at first patient contact by any health professional. It is widely used in clinical practice in the UK and internationally.</p> </td> </tr> <tr> <td valign="top"> <p>👓 Article/Book</p> </td> <td valign="top"> <p>2013</p> </td> <td valign="top"> <p>ICU Delirium and Cognitive</p> </td> <td valign="top"> <p><a href="http://www.icudelirium.org/resources.html" target="_blank" rel="noopener">http://www.<br />icudelirium.org/<br />resources.html</a></p> </td> <td valign="top"> <p>This website link provides a multitude of delirium assessment tools, complete with training manuals, flow and worksheets, and FAQs.</p> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>Guidelines</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p><strong>Best Practice Guidelines</strong></p> <p>👓 Article/Book</p> </td> <td valign="top"> <p>2010</p> </td> <td valign="top"> <p>NICE</p> <p>National Institute for Health and Care Excellence</p> </td> <td valign="top"> <p><a href="https://www.nice.org.uk/guidance/cg103/chapter/1-Guidance" target="_blank" rel="noopener">https://www.<br />nice.org.uk/<br />guidance/cg103/<br />chapter/<br />1-Guidance</a></p> </td> <td valign="top"> <p>Website addresses delirium in the adult population and discusses diagnosis, prevention and management in various clinical settings. It is well-recognized evidence-based guidance that sets the standard of quality of delirium care in hospitals and long term care settings.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Best Practice Guidelines</strong></p> <p>👓 Article/Book</p> </td> <td valign="top"> <p>2016</p> </td> <td valign="top"> <p>Canadian Agency for Drugs and Technologies in Health</p> </td> <td valign="top"> <p><a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0084861/" target="_blank" rel="noopener">http://www.ncbi.<br />nlm.nih.gov/<br />pubmedhealth/<br />PMH0084861/</a></p> </td> <td valign="top"> <p>Fully downloadable report on the Treatment of Older Adults with Insomnia, Agitation, or Delirium with Benzodiazepines: A Review of Clinical Effectiveness and Guidelines.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Best Practice Guidelines</strong></p> <p>👓 Article/Book</p> </td> <td valign="top"> <p>2014</p> </td> <td valign="top"> <p>American Geriatrics Society (AGS) Expert Panel on Postoperative Delirium in Older Adults.</p> </td> <td valign="top"> <p><a href="http://geriatricscareonline.org/ProductAbstract/american-geriatrics-society-clinical-practice-guideline-for-postoperative-delirium-in-older-adults/CL018/" target="_blank" rel="noopener">http://<br />geriatricscare<br />online.org/<br />ProductAbstract/<br />american-<br />geriatrics-<br />society-clinical<br />-practice-<br />guideline-for-<br />postoperative-<br />delirium-in-<br />older-adults/<br />CL018/</a></p> </td> <td valign="top"> <p>This American Geriatrics Society (AGS) clinical practice guideline was developed to identify evidence-based pharmacological and non-pharmacological strategies that should be implemented in the perioperative period for the prevention and treatment of postoperative delirium in older patients who are identified as at risk for delirium with delirium risk prediction models. Guideline development was based upon the AGS framework, with a standardized process for literature review, and rating the quality and strength of the recommendations. The nonpharmacological recommendations address (1) health professionals' education about delirium, (2) multicomponent interventions performed by an interdisciplinary team for delirium prevention and management, (3) identification and management of delirium's causes and (4) specialized hospital units. Pharmacological interventions address (1) anesthesia depth, (2) regional anesthesia, (3) analgesia, (4) avoidance of inappropriate medications, (4) medications including antipsychotics, cholinesterase inhibitors, benzodiazepines and medications for severe agitation, and (5) pharmacological management of hypoactive delirium.</p> <p>Please note that you must register for this article, but it is free.</p> </td> </tr> <tr> <td colspan="5" valign="top"> <p><strong><span style="font-size: small;"><em>Miscellaneous</em></span></strong></p> </td> </tr> <tr> <td valign="top"> <p><strong>Best Practice Guidelines</strong></p> <p>📄 Handout</p> </td> <td valign="top"> <p>2016<br />Updated</p> </td> <td valign="top"> <p>Delirium & Acute Encephal-<br />opathy Care Pathway</p> <p>ADAPT<br />(Actions for Delirium Assessment Prevent & Treatment), Hartford Hospital</p> </td> <td valign="top"> <p>Not available<br />at this time</p> <p><a href="/globalassets/practiceandpolicy/work-environment/nurse-staffing/delirium-trifold-brochure_2016dec.pdf" target="_blank" rel="noopener">See brochure<br />here</a></p> </td> <td valign="top"> <p>Brochure sponsored by ADAPT (Actions for Delirium Assessment Prevent & Treatment), Hartford Hospital. This brochure outlines drugs to limit and/or avoid, possible etiologies, various assessment methods, and several actions and assessments for the health care providers and patients.</p> </td> </tr> <tr> <td valign="top"> <p><strong>Professional Education</strong></p> <p>💻 Website</p> </td> <td valign="top"> <p>2017</p> </td> <td valign="top"> <p>American Nurses<br />Association</p> <p>Safe Patient<br />Handling and Mobility</p> </td> <td valign="top"> <p><a href="/practice-policy/work-environment/health-safety/safe-patient-handling/" target="_blank" rel="noopener">Handle with Care</a></p> </td> <td valign="top"> <p>This website contains tools, videos, and other resources that describe safe patient handling and mobility practices that can assist with early mobility. Early mobility can be beneficial in preventing and treating delirium.</p> </td> </tr> </tbody> </table> <p> </p> <p><em>Last edited 7/27/2017</em></p> </div> </div> </section></div><div class="block accordionitemblock grid__item one-whole large--two-thirds pad--large--one-third hasnav"> <section class="e-accordion__item" data-require="./src/views/accordion-item-view" data-collapse-panel="true" data-gtm-event-action="/practice-policy/work-environment/health-safety/delirium/" data-gtm-event-label="References" > <a class="e-accordion__toggle" href="#" data-accordion-toggle> <h2 class="e-accordion__toggle-title">References</h2> </a> <div class="e-accordion__item-content" data-accordion-content> <div class="e-richtext"> <table border="0"> <tbody> <tr> <td colspan="2" valign="top"> <p><strong>General</strong></p> </td> </tr> <tr> <td valign="top"> <p>De, J., & Wand, A. F. (2015). <a href="https://academic.oup.com/ageing/article/44/2/196/93749" target="_blank" rel="noopener">Delirium screening: A systematic review of delirium screening tools in hospitalized patients</a>. <em>The Gerontologist, 55</em>(6), 1079-1099. doi:10.1093/geront/gnv100</p> </td> <td valign="top"> <p>This review aimed to identify, compare, and evaluate delirium screening tools used in non-critically ill hospitalized patients and to provide guidance on using the tools in different patient populations. A search of MEDLINE, CINAHL, and PsychInfo databases identified 31 studies of 21 delirium screening tools. Most studies were conducted in mixed populations of older hospitalized patients. Others were conducted in surgical, emergency department, oncology, and palliative care patients exclusively. The Confusion Assessment Method (CAM) was the most widely studied tool. Considerations for selecting a delirium screening tool and suggestions for using specific tools in different populations are provided.</p> </td> </tr> <tr> <td valign="top"> <p>Hshieh, T. T., Yue, J., Oh, E., Puelle, M., Dowal, S., Travison, T., & Inouye, S. K. (2015). <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2107611" target="_blank" rel="noopener">Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis</a>. <em>JAMA Internal Medicine, 175</em>(4), 512-520. doi:10.1001/jamainternmed.2014.7779</p> </td> <td valign="top"> <p>This study drew articles from PubMed, Google Scholar, ScienceDirect, and the Cochrane Database of Systematic Reviews and specifically looked at 14 studies for the impact of 12 unique nonpharmacological interventions on delirium incidence, falls, length of stay, rate of discharge to a long term institutionalization, and change in status (functional or cognitive). Interventions were based on Hospital Elder Life Program (HELP) protocols. Meta-analysis was performed only for outcomes of delirium incidence, falls, length of stay, and institutionalization. Authors summarize that non-pharmacologic interventions have shown to decrease not only delirium incidence but preventing falls, an outcome that has not been as well investigated as other outcomes.</p> </td> </tr> <tr> <td valign="top"> <p>Inouye, S. K., Westendorp, R. J., & Saczynski, J. S. (2014). <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120864/" target="_blank" rel="noopener">Delirium in elderly people</a>. <em>Lancet, 383</em>(9920), 911-922. doi:10.1016/S0140-6736(13)60688-1</p> </td> <td valign="top"> <p>A review was performed of original articles on delirium occurring in those aged 65 and older. Utilizing the data bases of Medline, PubMed, article reference lists, and other reviews, articles published between 1990-2012 were selected. The epidemiology, diagnosis, etiology, pathophysiology, evaluation, prevention and treatment methods, controversies, and recommendations for research regarding delirium in the elderly were summarized. Findings for elderly patients with delirium were listed. These included: use cognitive screening and the CAM on all elderly hospitalized patients for delirium; evaluate the necessity of medications prescribed; use nonpharmacological approaches when appropriate; involve the patient’s family; encourage movement; involve patient in care and self-care; ensure availability of assistive devices; and keep patients informed of their schedule.</p> </td> </tr> <tr> <td valign="top"> <p>Kalish, V. B., Gillham, J. E., & Unwin, B. K. (2014). <a href="http://www.aafp.org/afp/2014/0801/p150.html" target="_blank" rel="noopener">Delirium in older persons: evaluation and management</a>. <em>American Family Physician, 90</em>(3), 150-158.</p> </td> <td valign="top"> <p>This article provides a concise yet comprehensive overview of best practices in evaluation and management of delirium in diverse settings. After presenting a case study, the article summarizes the definition, diagnostic criteria, incidence, prevalence and risk factors for delirium. Methods to identify delirium are provided, including the Confusion Assessment Method (CAM) and recommendations are given for appropriate evaluation of associated symptoms to identify underlying illnesses. The article reviews non-pharmacologic and pharmacologic interventions and best practices. This is a useful resource for nurses and advanced practice nurses working in all settings including ICU, acute care, long-term care, community and hospice. CME credits offered.</p> </td> </tr> <tr> <td valign="top"> <p>Maldonado, J. R. (2013). <a href="http://www.sciencedirect.com/science/article/pii/S1064748113003527" target="_blank" rel="noopener">Neuropathogenesis of delirium: Review of current etiologic theories and common pathways</a>. <em>American Journal of Geriatric Psychiatry, 21</em>(12), 1190-1222. doi:10.1016/j.jagp.2013.09.005</p> </td> <td valign="top"> <p>This article is a review of the literature and summary of the seven proposed theories that attempts to explain what happens on a neuronal level during illness leading to the cognitive and behavioral changes seen in delirium. These theories include: Neuroinflammatory, Neuronal Aging, Oxidative, Neurotransmitter, Neuroendocrine and Network Disconnectivity Hypotheses. The article further discusses how these theories complement each other and the intersections and reciprocal influences they share.</p> </td> </tr> <tr> <td valign="top"> <p>Martinez, F., Tobar, C., & Hill, N. (2015). <a href="https://academic.oup.com/ageing/article/44/2/196/93749" target="_blank" rel="noopener">Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature</a>. <em>Age and Ageing, 44</em>(2), 196-204. doi:ageing/afu173</p> </td> <td valign="top"> <p>This study obtained articles from 7 data bases including PubMed/MEDLINE, EMBASE, PsychInfo, CINAHL, Cochrane Library, Cochrane Register Controlled Trials (CENTRAL), LILACS, ScieELO, and grey literature repositories. A systematic review of randomized trials included 7 studies exploring multicomponent interventions to reduce delirium incident and accidental falls during hospitalization. A non-significant reduction in delirium duration, hospital stay and mortality were also discovered. Authors summarized the systematic review and meta-analysis, thus concluding that multicomponent interventions were effective in reducing incident of delirium and reducing accidental falls. The effects did not differ according to clinical setting and should be standard of care for elderly inpatients.</p> </td> </tr> <tr> <td valign="top"> <p>Yue, J., Tabloski, P., Dowal, S. L., Puelle, M. R., Nandan, R., & Inouye, S. K. (2014). <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020349/" target="_blank" rel="noopener">NICE to HELP: Operationalizing National Institute for Health and Clinical Excellence Guidelines to improve clinical practice</a>. <em>Journal of the American Geriatrics Society, 62</em>(4), 754-761. doi:10.1111/jgs.12768</p> </td> <td valign="top"> <p>The purpose of the article was to share results of a rigorous process to align intervention protocols of the HELP program with the NICE guidelines. The authors conducted a systematic review of all English language articles that were accessed through the PubMed and CINAHL databases from January 1, 2008 through December 31, 2012 on the topics of hypoxia, infection, and pain, which were part of the NICE guidelines, but were not included in the HELP program. Likewise, they explored the same literature to expand the existing dehydration protocol in the HELP program so as to include constipation as one of the target areas. As a result, the NICE guidelines for delirium prevention were fully operationalized and align with the HELP program.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>Surgical</strong></p> </td> </tr> <tr> <td valign="top"> <p>American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. (2015). <a href="http://onlinelibrary.wiley.com/doi/10.1111/jgs.13281/full" target="_blank" rel="noopener">American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults</a>. (2015). <em>Journal of the American Geriatrics Society, 63</em>(1), 142-150. doi:10.1111/jgs.1328</p> </td> <td valign="top"> <p>This American Geriatrics Society (AGS) clinical practice guideline was developed to identify evidence-based pharmacological and non-pharmacological strategies that should be implemented in the perioperative period for the prevention and treatment of postoperative delirium in older patients who are identified as at risk for delirium with delirium risk prediction models. Guideline development was based upon the AGS framework, with a standardized process for literature review, and rating the quality and strength of the recommendations. The nonpharmacological recommendations address (1) health professionals’ education about delirium, (2) multicomponent interventions performed by an interdisciplinary team for delirium prevention and management, (3) identification and management of delirium’s causes and (4) specialized hospital units. Pharmacological interventions address (1) anesthesia depth, (2) regional anesthesia, (3) analgesia, (4) avoidance of inappropriate medications, (5) medications including antipsychotics, cholinesterase inhibitors, benzodiazepines and medications for severe agitation, and (6) pharmacological management of hypoactive delirium.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>ICU</strong></p> </td> </tr> <tr> <td valign="top"> <p>Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., Peitz, G. J., & Ely, E. W. (2012). <a href="http://ccn.aacnjournals.org/content/32/2/35.long" target="_blank" rel="noopener">Critical care nurses' role in implementing the "ABCDE bundle" into practice</a>. <em>Critical Care Nurse, 32</em>(2), 35-38, 40-47; quiz, 48. doi:10.4037/ccn2012229</p> </td> <td valign="top"> <p>This article focuses on the implementation of the “ABCDE Bundle” as an evidenced based strategy to decrease the incidence an duration of delirium in the ICU setting. Awakening and breathing, delirium monitoring and early mobilization are strategies that are proven to help lessen the negative effects of an ICU admission. The article reviews the evidence, the importance of the inter-professional team as well as the importance of consistent adherence to the bedside routines to create successful implementation. A strength of the article is a real time “walk through” of how the bundle is implemented in the clinical setting. It includes many useful charts and work flow diagrams which make this article highly appealing for bedside providers.</p> </td> </tr> <tr> <td valign="top"> <p>Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gelinas, C., Dasta, J. F., Davidson, J., E., Devlin, J. W., Kress, J. P., Joffe, A. M., Coursin, D. B., Herr, D. L., Tung, A., Robinson, B. R. H., Fontaine, D. K., Ramsay, M. A., Riker, R. R., Sessler, C. N., Pun, B., Skrobik, Y., & Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. <em>Critical Care Medicine</em>, <em>41</em>(1), 263-306. Doi: 10.1097/CCM.0b013e3182783b72</p> </td> <td valign="top"> <p>The article updates and includes evidence-based guidelines and recommendations for healthcare professionals for the prevention and management of delirium in the critical care setting. This was done by an interdisciplinary task force of twenty individuals over a six year period.</p> </td> </tr> <tr> <td valign="top"> <p>Trogrlic, Z., van der Jagt, M., Bakker, J., Balas, M. C., Ely, E. W., van der Voort, P. H., & Ista, E. (2015). <a href="http://ccforum.biomedcentral.com/articles/10.1186/s13054-015-0886-9" target="_blank" rel="noopener">A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes</a>. <em>Critical Care, 19</em>(1), 157-157. doi:10.1186/s13054-015-0886-9</p> </td> <td valign="top"> <p>This study was a systematic review of 21 articles pulled from 5 different databases (PubMed, Embase, PsychINFO, Cochrane and CINAHL) that analyzed the implementation strategies for assessment, prevention and management of ICU delirium. All of the studies reviewed included process measures and nine of the studies used both process measures and clinical outcomes. Results from the study showed that implementation of successful interventions often changed process measures but strong data supporting outcome measures was not evident. The study’s findings indicated that implementing multi-component programs with more strategies that targeted ICU delirium assessment; prevention and treatment are more likely to improve clinical outcomes when combined with pain agitation and delirium (PAD) or awakening, breathing coordination, choice of sedative, delirium monitoring and early mobility (ABCDE) bundles.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>Cancer</strong></p> </td> </tr> <tr> <td valign="top"> <p>Lawlor, P. G., & Bush, S. H. (2015). Delirium in patients with cancer: assessment, impact, mechanisms and management. <em>Nature Reviews Clinical Oncology</em>, <em>12</em>(2), 77-92. doi:10.1038/nrclinonc.2014.147</p> </td> <td valign="top"> <p>This comprehensive review looks at delirium in patients with cancer. The authors searched MEDLINE and Scopus databases for articles between January 1990 and October 2013. It acknowledges that delirium is common with rates up to 90% with advanced cancer. The authors review validated assessment tools available for screening, and monitoring the severity of Delirium. They also discuss predisposing and precipitating factors, reversibility of delirium, and pathophysiology of delirium in the cancer population. Lastly, the article discusses non-pharmacological and pharmacological interventions to treat delirium and refractory delirium.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>Palliative</strong></p> </td> </tr> <tr> <td valign="top"> <p>Hosie, A., Davidson, P. M., Agar, M., Sanderson, C. R., & Phillips, J. (2013). Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. <em>Palliative Medicine, 27</em>(6), 486-498. doi:10.1177/026921631245721</p> </td> <td valign="top"> <p>The purpose of this article was to look at how delirium occurrence was measured in inpatient palliative or hospice settings and to also report on the overall quality and results of that research. A total of eight articles published from 1980 until now were included in this systematic review across the CINAHL and Medline databases. The authors found that the majority of research included both delirium screening and formal assessment, typically diagnosed using DSM criteria. Eight different screening and assessment tools were used across the studies, including delirium tools (i.e., CAM or DRS) and cognition tools (i.e., MMSE). Overall results found that delirium occurrence was lowest upon admission and increased closer to the time of death, with rates as high as 88%. Hypoactive delirium was also found to be the most predominant subtype in this population.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>Delirium & Dementia</strong></p> </td> </tr> <tr> <td valign="top"> <p>Fong, T. G., Davis, D., Growdon, M. E., Albuquerque, A., & Inouye, S. K. (2015). The interface between delirium and dementia in elderly adults. <em>The Lancet Neurology</em>, <em>14</em>(8), 823-832.</p> </td> <td valign="top"> <p>This paper reviews scientific evidence from laboratory and clinical studies that support a link between delirium and dementia. The paper describes evidence that supports the role of dementia as an independent risk factor for delirium; delirium as an independent risk factor for dementia; and evidence from clinicopathological, neuroimaging and biomarker studies that suggest both shared and distinct mechanisms of neuronal injury. The role of delirium as a marker of brain vulnerability, mediator of noxious insults and/or contributor to neuronal damage is described. This paper is useful for nurses seeking deeper understanding of the relationship between acute and chronic cognitive impairment.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>Family</strong></p> </td> </tr> <tr> <td valign="top"> <p>Halloway, S. (2014). A family approach to delirium: a review of the literature. <em>Aging & Mental Health, 1</em>8(2), 129-139. doi:10.1080/13607863.2013.814102</p> </td> <td valign="top"> <p>This article reviews studies that explore a family approach to the prevention and management of delirium. It explores the current state of research related to delirium identification and treatment through the lens of family involvement. The review exposes a need for much further exploration and research on the use of family in the management of delirium, especially for the at risk elder patient. The majority of studies reviewed were lower level evidence but two high quality studies, one multi-component intervention and one bedside intervention improved delirium outcomes significantly. Eleven articles met criteria for the review, which demonstrated a need to further explore this understudied topic.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>Pediatrics</strong></p> </td> </tr> <tr> <td valign="top"> <p><a href="http://www-ncbi-nlm-nih-gov.proxy.library.vanderbilt.edu/pubmed/?term=Kelly%20P[Author]&cauthor=true&cauthor_uid=22959060" target="_blank" rel="noopener">Kelly P.</a> & <a href="http://www-ncbi-nlm-nih-gov.proxy.library.vanderbilt.edu/pubmed/?term=Frosch%20E%5BAuthor%5D&cauthor=true&cauthor_uid=22959060" target="_blank" rel="noopener">Frosch E.</a> (2012). Recognition of delirium on pediatric hospital services. <em>Psychosomatics</em>, <em>53</em>(5), 446-51. doi: 10.1016/j.psym.2012.04.012.</p> </td> <td valign="top"> <p>A retrospective chart review noting that out of 515 pediatric patients in which psychiatry was consulted; only 6 of the consults were delirium noted by the medical team. An additional 47 were diagnosed with delirium by psychiatry, which means the medical team missed 88%. The article brings to light not only the need for the use of bedside tools to detect delirium by the medical staff but also the importance of the psychiatry team.</p> </td> </tr> <tr> <td valign="top"> <p>Williams, S. R. (2016). How to recognize delirium in pediatric patients. <em>American Nurse Today</em>, <em>11</em>(5), 8-11.</p> </td> <td valign="top"> <p>This article provides nurses an overview on how to identify delirium in the pediatric patient. It gives detailed information on commonly used delirium assessment tools used specifically for the pediatric population. Each description includes the tool’s background, sensitivity/specificity, and age range. Nursing actions are then listed with the appropriate reasoning behind the action, as well as suggestions for care in specific circumstances.</p> </td> </tr> <tr> <td colspan="2" valign="top"> <p><strong>Early Mobility</strong></p> </td> </tr> <tr> <td valign="top"> <p>Balas, M. C., Vasilevskis, E. E., Olsen, K. M., Schmid, K. K., Shostrom, V., Cohen, M. Z., Peitz, G., Gannon, D. E., Sisson, J., Sullivan, J., Stothert, J., C., Lazure, J., Nuss, S. L., Jawa, R., S., Freihaut, F., Ely, E. W., & Burke, W. J. (2014). Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. <em>Critical Care Management</em>, <em>42</em>(5), 1024-36. DOI: 10.1097/CCM.0000000000000129</p> </td> <td valign="top"> <p>This article evaluates the effectiveness as well as the safety of implementing the Awakening, Breathing, Coordination, Delirium monitoring/management and Early Exercise mobility (ABCDE) bundle into everyday practice. Following 296 patients this study was an eighteen-month prospective, cohort, before-after study. Regression models were used to quantify relationships between the ABCDE bundle and prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge and change in residence. Results of the study showed that critically ill patients who were managed with the ABCDE bundle spent three more days breathing without assistance, were more likely to be up and mobile during their ICU stay and experienced less delirium than patients who were treated with usual care not including the ABCDE bundle.</p> </td> </tr> <tr> <td valign="top"> <p>Balas, M. C., Burke, W. J., Gannon, D., Cohen, M., Z., Colburn, L., Bevil, C., Franz, D., Olsen, K., M., Ely, E. W., & Vasilevskis, E. E. (2013). Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: Opportunities, challenges, and lessons learned for implementing the ICU pain, agitation and delirium guidelines. <em>Critical Care Management</em>, <em>41</em>(9), S116-S127. DOI: 10.1097/CCM.0b013e3182a17064</p> </td> <td valign="top"> <p>The purpose of this was to examine what worked and what did not when implementing the ABCDE bundle in a prospective study in multiple units in an academic medical center. The 18 month project focused on barriers and facilitators for interdisciplinary staff implementing the bundle. Four factors were identified that helped implementation (e.g. daily rounds of interdisciplinary team, commitment of operational leaders) and five barriers were noted (treatment issues like timing of interventions, workload). Both survey and focus groups with the participants revealed they felt the bundle caused an improvement in practice.</p> </td> </tr> </tbody> </table> </div> </div> </section></div><div class="block linklistblock grid__item one-whole large--two-thirds pad--large--one-third hasnav"> <section class="c-in-page-link-list"> <h2 class="e-link-list__heading"> Delirium Survey </h2> <ul class="c-in-page-link-list__list"> <li class="e-download-cta__item"> <a href="/globalassets/practiceandpolicy/innovation--evidence/delirium-survey-ppt-20160517rev.pdf" class="e-download-cta" target="_blank" label="Summary of ANA's Delirium Survey"> <div class="e-download-cta__content"> <div class="e-download-cta__heading">Summary of ANA's Delirium Survey</div> <span class="e-download-cta__file-type">pdf (0.65MB)</span> <span class="e-icon-list__item e-icon-list__item--icon-file-pdf icon icon--icon-file-pdf e-download-cta__file-icon"></span> </div> </a> </li> </ul> </section> </div><div class="block linklistblock 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