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The aim of the current study was to report findings about delirium detection when ward nurses screened for delirium in patients with cognitive impairment using the Delirium Observation Screening Scale (DOSS) in comparison to the Confusion Assessment Method (CAM). A secondary analysis was performed of research data collected in 2010 at a Swiss tertiary university hospital. During the first 5 days after admission, patients 70 and older with cognitive impairment were screened for delirium using the DOSS. Throughout patients' hospital stay, research assistants also completed the CAM on a daily basis. A total of 138 patients who did not have delirium initially participated in the study. Of these patients, 44 (32%) developed delirium with a median duration of 3 days (Q1 = 1.25; Q3 = 5.00). Ward nurses correctly identified delirium using the DOSS in 56% of cases (sensitivity) and no delirium in 92% of cases (specificity). Although the DOSS was 100% correct in detecting patients with hyperactive delirium, the identification rate decreased to 60% for patients with mixed delirium subtype and 38% for patients with hypoactive delirium. Delirium screening using observational methods may be insufficiently sensitive and should be supplemented with a formal attention test. [Journal of Gerontological Nursing, 44(12), 35-43.]., (© 2018 Hasemann, Tolson, Godwin, Spirig, Frei, Kressig.)

Background: Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case., Methods: This cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29'278 patients hospitalized in the study hospital in 2014 were included. Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4., Results: Of 10'906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2-40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6-28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group's delirious patients had worse outcomes compared to those with no delirium., Conclusions: The results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups.

Background: Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear., Aim: To determine the effects of DemDel, a comprehensive delirium management programme, in inpatient acute care elders with cognitive impairment., Design and Methods: This paper reports the quantitative part of a mixed methods study, comparing an intervention with treatment as usual using validated outcome measures. After training, ward nurses and physicians administered the intervention based on the DemDel algorithm that focused on delirium prevention, including an intensive systematic screening schedule for cognitive impairment and delirium, as well as comprehensive delirium management. The delirium management regimen included timely administration of pro re nata medication., Settings: The study was conducted within four medical wards of an acute care university hospital in urban Switzerland., Participants: A total of 268 patients with cognitive impairment participated in the pre/post comparison study. The intervention and treatment as usual groups consisted of 138 and 130 patients, respectively., Results: Eighty-seven (32.5%) out of 268 patients developed delirium, of whom 51 (58.6%) were of mixed, 10 (11.5%) hyperactive and 26 (29.9%) hypoactive delirium subtypes. Delirium appeared within the first five days after admission in 81.6% of cases. The 44 (31.9%) patients with delirium in the intervention group with systematic delirium management had less severe episodes of delirium and required medication for management than the 43 (33.1%) delirious patients in the control group. Intervention compliance was good on three of the four units., Conclusions: The DemDel programme was effective with regard to improvement of outcomes associated with delirium in patients with cognitive impairment. The intervention was feasible and possible to be embedded within routine practice on four busy general medical wards., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Based on actual evidence, about one third of deliria can be prevented. Hereby, preventive measures can address both delirium predisposing as well as delirium precipitating factors., Methods: In 2004 an interdisciplinary practice developmental project was developed, implemented and evaluated at the University Hospital Basel by action-based research., Interventions: Preventive measures for delirium were developed, resource nurses trained and a systematic delirium screening procedure established., Results: Nurses and doctors highly accepted the common approach. The delirium rate declined from 25% to 11%. The working load for nurses did not increase on the intervention wards, but decreased at night, whereas the night working load increased on the control wards., Conclusion: An interprofessional and interdisciplinary approach for the prevention of delirium has multiple winners: the patient, nurses and doctors.

The prevalence of deliria is increasing exponentially with cumulative age. At the University Hospital of Basel 16 % of patients in the 70-79 year age-group, 27 % in the 80-89 year age-group and 39 % of the over 90 year old are rated as confused and disoriented. Delirious patients suffer from functional decline and show a significant higher mortality and institutionalization rate after hospital discharge. Nurses have an important role in the multi-component delirium-management. In addition to the assessment of medication, laboratory parameters, oxygenation or urinary excretion, patient-oriented evaluations, pain and stress management, assessment of patient perception and communication are of particular importance. To meet these goals, nurses need knowledge, education and proof of clinical evidence.

Background: Delirium in elderly hip-fracture patients is common and results in negative patient outcomes and increased nursing workload., Design and Objective: The study was part of an evaluation of the interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) in a Swiss university hospital. Nursing workload was compared before and after implementing the program, using a quasi-experimental design., Participants: Included were 200 patients who were 65 years of age or older, recovering from hip-fracture surgery on a trauma ward (intervention) or on the other surgery wards., Methods: Workload was compared before and after implementing the program on the trauma ward and was also compared on other surgery wards. Nursing workload for each patient was evaluated by means of data obtained from the nursing workload management system. Data were collected in a 4-month timeframe in 2004 and 2005 respectively. Differences for workload in total and workload for day, evening, and night shifts on postoperative days 1-5 were calculated, controlled by co-morbidity. Subgroup analysis was performed for patients categorized by nurses as 'confused'., Results: Total workload decreased slightly from Year 1 to 2 by 6.4% and 4.2% for patients on the trauma ward and other surgery wards. However, workload during night shifts on the trauma ward decreased significantly by 22% (p=.004), while there was not a significant change on the other surgery wards. Sub-analyses for 'confused' patients found that the workload at night on the trauma ward decreased significantly by 23% (p=.01), while it did not change significantly on other surgery wards. Higher co-morbidity and nurses' labelling patients as 'confused' were associated with increased workload (p<.001)., Conclusions: After implementing the program, decreased workload at night was found on the trauma ward. Delirium was detected and treated more quickly which led to less care needed at night. The reason for the slight drop in workload on all wards requires further investigation.

Delirium is an acute decline in attention and cognition. To make a diagnosis, there are two classification systems: the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10). While the core criteria are similar in both systems, ICD-10 requires three additional criteria to make a diagnosis: disturbed psychomotor behaviour and sleep-wake-cycle and emotional disturbances. Thus, making a diagnosis according to ICD-10 criteria is more stringent. Depending on the population, up to 60 percent of patients with delirium, diagnosed by DSM-IV criteria, are missed by ICD- 10. In clinical practice, several screening and assessment instruments are available. Most of them are based on DSM-IV criteria. In this article, two instruments will be discussed, which have been used by nurses in the Basel Delirium Management Program in Switzerland. Screening for delirium is accomplished with the Delirium Observatie Screening Schaal (DOS) Scale developed by Schuurmans (2001). For assessment, the Confusion Assessment Method (CAM), developed by Inouye, is used. While the DOS is a classical observation instrument, the CAM requires a structured interview, similar to the Mini-Mental State Exam by Folstein. Both the DOS and CAM instruments were scientifically translated into German. This article will present the translated versions of both DOS and CAM, report their use in a Swiss population of patients at risk for delirium and provide the theoretical background of diagnosing delirium with the criteria of the DSM-IV and ICD-10.