Delirium Education in Hospice Care A Quality Improvement Project

Diagnosing delirium in hospice patients is challenging owing to the multifactorial causes and symptoms of delirium that can mimic natural end-of-life processes. When delirium goes unrecognized in hospice patients, preventable causes can be left untreated, leading to sequelae that are misaligned with the principles of hospice care. We conducted an evidence-based quality improvement project on a 10-bed inpatient hospice unit aimed at increasing nursing staff knowledge about assessing delirium, with a focus on preventable causes. Nurses were trained in use of the Nursing Delirium Screening Scale, which was implemented over a 5-week period. Increases in knowledge were evaluated with a pretest and posttest. We used a paired t test to determine knowledge improvement. Use of the tool was evaluated using a survey. Nurses demonstrated significantly improved knowledge after the educational session (P = .009). Survey results indicated overwhelmingly that nurses valued having an easy-to-use tool to assess delirium in their patients. Because we used a paper-based tool during the project, which was found to be cumbersome by staff, our next steps are to determine the feasibility of implementing the tool into the electronic medical record.