Pilot Study of a Two-Step Delirium Detection Protocol Administered By Certified Nursing Assistants, Physicians, and Registered Nurses.
Donna M Fick, Sharon K Inouye, Caroline McDermott and 8 others
PMID 29596707WHAT IT FOUND
In 23 older hospitalized patients, physicians and nurses could complete a two-step delirium screen, and nursing assistants could complete the two-question screen.
Reference standard found delirium in five patients, but the pilot was small.
Key findings
01Twenty-three patients were analyzed, and five had delirium by the reference standard.
02The pilot suggests the two-item screener had high sensitivity and moderate specificity, and the full two-step protocol retained very good to excellent sensitivity and substantially improved specificity.
03Qualitative analysis found seven themes: three facilitators and four barriers, including time, excessive prompting, communication breakdowns, and severe cognitive impairment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 23 patients were analyzed, and confidence intervals were not calculated because the study was a pilot. The sample was 100% white and included only general medicine patients aged 70 or older with expected stays of at least two days. One patient was excluded because the assessments were nearly four hours apart and the patient was noted to be fluctuating. The article text does not report the actual pilot sensitivity or specificity values. The study tested feasibility and preliminary detection, not patient outcomes or the effect of treatment.
The easy way to misread this
Do not conclude that this pilot proves the protocol improves delirium detection or patient outcomes. It analyzed 23 patients, did not calculate confidence intervals, and the article text does not report the actual sensitivity or specificity values.