Prevention and management of postoperative delirium in adult patients: a best practice implementation project.
Juliana Rizzo Gnatta, Sarha de Oliveira Gonçalves Paes, Maria Fernanda de Oliveira Faria and 5 others
PMID 39997608WHAT IT FOUND
Training and a CAM-ICU workflow raised staff adherence to several delirium care criteria in an audit of 10 PACU patients.
Sedation-depth monitoring stayed at zero because BIS equipment was not acquired.
Key findings
01The baseline audit found no compliance with audit criteria 1 to 7.
02Compliance improved in four of nine audited criteria compared with baseline, and seven of nine criteria increased.
03Adherence to criterion 1, monitoring depth of sedation, was zero in follow-up audits because BIS equipment was not acquired.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-site PACU audit with 10 patient records and 10 nurses and 10 anesthesiologists in each audit, so compliance rates may not generalize. No control group was used, and the implementation bundle included training, printed CAM-ICU, an algorithm, and electronic record changes, so the contribution of any single component cannot be separated. The audit measured adherence to best-practice criteria, not patient outcomes such as delirium duration, length of stay, or safety. Staff turnover and new training before the second follow-up audit mean the project could not verify whether changes were sustained over one year. BIS equipment was not acquired during the project, so one recommended practice for monitoring depth of sedation was not implemented.
The easy way to misread this
Do not read improved compliance as proof that this programme reduced postoperative delirium or improved patient outcomes. The project measured adherence to screening and documentation criteria, not patient outcomes such as delirium duration, length of stay, or safety.