PP11 – Case Management’s Contribution to the Prevention and Treatment of Delirium
Delirium is a condition that can follow patients across the continuum of care resulting in significant consequences. Increased mortality risk and decrease in cognitive function are a few of the many consequences experienced. Short and long term consequences of interest to Case Managers include, length of stay, cost of care, post discharge disposition, and others.
A team was created to implement a Delirium Prevention and Intervention program with the goal of impacting clinical and operational variables. This included implementation of the ABCDEF bundle as a comprehensive, research based strategy. Early mobilization is part of this bundle which was implemented over two years ago.
The early mobilization strategy began in the Intensive Care Units (ICUs) on ventilated patients. The team is led by the Case Managers in the ICUs. Other members of the multidisciplinary team include Physical Therapy, Respiratory Therapy and the RN caring for the patient. A standardized safety screen tool was developed and used to evaluate the patient using clinical criteria such as myocardial stability, oxygenation status, use of vasopressors, and pain/sedation levels. Mobilization ranges from standing at the bedside to walking in the hall with their ventilator. Those not ventilated in the ICU or across the bedside to waling in the hall with their ventilator. Those not ventilated in the ICU or across the Acute Care Service are evaluated daily using the Banner Mobility Assessment Tool.