Documentation and Management of Words Associated With Delirium Among Elderly Patients in Postacute Care: A Pilot Investigation

Objective

To describe in a pilot investigation the frequency that keywords associated with delirium were documented by providers and to study the effect of reporting such observations on physician orders.

Design

Retrospective investigation.

Settings and Participants

Eighty elderly patients identified from 895 admitted to 2 postacute care (PAC) facilities.

Measurements

Keywords associated with delirium were confusion, disorientation, altered mental status, delirium, agitation, inappropriate behavior, mental status change, inattention, hallucination, and lethargy. The source of the words and actions taken were recorded.

Results

Keywords associated with delirium were identified in 80 (9%) of 883 patients who met inclusion criteria, with the term “confusion” most frequently noted (95%). Nurses and physicians recorded keywords in 79 (99%) and 55 (69%) patient charts. The actual term “delirium” was used in only 6 (7%) of 80 cases. In 55 (69%) cases when physicians were notified, treatments or evaluations were performed: pharmacological 55 (100%), nonpharmacological 11 (20%), assessments 38 (69%), transfer to the emergency department 19 (34%). Nurses did not alert physicians in 25 (31%) cases where keywords were found and thus no action was taken in these cases.

Conclusions

In this pilot investigation in the postacute setting, nurses and physicians documented words associated with delirium in 9% of the patient charts. When nurses notified physicians of patients with charted keywords suggesting delirium, physicians responded with orders for further assessments or pharmacological interventions. However, nurses did not refer patients with keywords in 1 of 3 cases and no actions were documented in the charts for these patients.

Keywords: Altered mental status, delirium, treatment, postacute, rehabilitation