Understanding the barriers to recognition and management of delirium in the acute post : surgical setting [Final Report February 2008]

Post-surgical delirium has been shown to be a significant problem in the elderly patient. However, it remains a disorder that is not well recognised nor wellunderstood by health care providers.1 The purpose of this study was to investigate current assessment practices as well as potential barriers to accurate assessment in relation to delirium, within a major Australian tertiary referral hospital. Patients aged 65 and over were recruited on, or close to, admission, from a pre surgical cohort over a six month period in 2007. After consent was gained, they were assessed by a nurse researcher, using a Mini Mental State Examination (MMSE)and Confusion Assessment Method (CAM) to determine their preoperative cognitive state and the presence or absence of delirium. Demographic data was also collected. The recruited patients were then assessed again by the researcher for delirium using the CAM, on both day one and day three post surgery. Patients’ charts were audited at the same times and again at discharge to see if, and how, delirium had been assessed, diagnosed and managed by the healthcare staff during the admission. Post surgical complications and prospective patient data were collected from medical records. Focus groups were also conducted with medical and nursing staff to ascertain what current and common practices were followed in relation to the assessment, diagnosis and management of delirium. Following the findings of the study, the authors then offer recommendations to improve outcomes for elderly surgical patients in this, and similar facilities.