Date of Award

2019-05-25

Degree Name

PhD Nursing

Dissertation Committee

Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN; Ann M. Mayo, DNSc, RN, FAAN; Jacqueline Close, PhD, RN, CNS; Caroline Etland, PhD, RN, CNS

Keywords

Delirium in PAC, Delirium in LTC, Older adult, Cognitive impairment

Abstract

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, gender, race), principal admitting diagnosis, admission source, discharge disposition, medication management (polypharmacy, psychotropic medications duration), presence of dementia, CHART-DEL-derived delirium diagnoses documented delirium symptoms and International Classification of Disease, 10th revision (ICD 10) coded delirium, LOS, Charlson score (comorbidities). Statistical methodology included: descriptive statistics for demographic and other variable data. Chi square for relationship between delirium and the independent variables. ANOVA described the difference between the variables. Multiple logistic regression determined the odds of having a delirium diagnosis (by either approach with separate models) based upon gender, race, principle admitting diagnosis, polypharmacy, dementia, age, LOS, Charlson score (comorbidities), and psychotropic medications duration.

Results: Majority residents were female, white, average age 80.6, 99.4% acute care admissions, and 96.6% had polypharmacy. Psychotropic duration mean was 9.5 days,

LOS 14.7 days, and 64.9% discharged home with home health. More delirium identified with CHART-DEL-derived delirium diagnoses (24.9%) compared to ICD-10 code diagnosis (5.2%). The Charlson score (comorbidity) was related to delirium in both models (CHART-DEL-derived p = .044; ICD-10 code p = .002), while LOS additionally explained variance, but only in CHART-DEL-derived delirium model.

Conclusions: The daily use of a delirium-screening instrument by the healthcare team could assist with delirium identification sooner and implement appropriate interventions. This then could decrease negative outcomes of delirium, improve satisfaction among family and staff and increase resident quality of care and safety.

Document Type

Dissertation: Open Access

Department

Nursing

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