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Evidence-Based Clinical Audit Criteria for the Prevention and Management of Delirium in the Postoperative Patient With a Hip Fracture

Holly, Cheryl; Rittenmeyer, Leslie; Weeks, Susan Mace

doi: 10.1097/NOR.0000000000000020

Delirium is a frequent, yet often unrecognized, occurrence in elderly hospitalized patients. In patients with hip fracture, the incidence of delirium is reported to be as high as 62% and even greater if over 65 years of age. One approach to the prevention and management of postoperative delirium in elderly patients with hip fracture is the clinical audit. A clinical audit is a retrospective assessment of clinical care of patients and is guided by criteria that are evidence-based statements of best practice. The use of measurable, objective criterion, with an agreed standard of performance is the hallmark of an audit. The clinical audit criteria presented in this article for the prevention and management of delirium in hospitalized elderly with hip fracture were determined by a compilation of systematic reviews and existing evidence-based clinical guidelines. The following 5 audit criteria are discussed: (1) All elderly patients with a hip fracture are assessed for risk factors for developing delirium daily using a valid and reliable tool; (2) the environment of the patient with hip fracture is assessed daily for conduciveness to maintaining sensory orientation; (3) all patients with hip fracture receive essential nursing care; (4) appropriate clinical criteria are applied to confirm a diagnosis of delirium in patients with hip fracture; and (5) nonpharmacologic interventions are employed before pharmacologic interventions in patients with hip fracture with a diagnosis of delirium.

Cheryl Holly, EdD, RN, ANEF, Professor, and Co-Director, Northeast Institute for Evidence Synthesis and Translation, Rutgers School of Nursing (formerly UMDNJ), Newark, NJ.

Leslie Rittenmeyer, PsyD, RN, CNE, Professor, Deputy Director for Synthesis Science, Indiana Center for Evidence Based Nursing Practice, A Collaborating Center of the Joanna Briggs Institute, Purdue University Calumet School of Nursing, Hammond, IN.

Susan Mace Weeks, DNP, RN, CNS, LMFT, FAAN, Associate Dean and Associate Professor, Director, TCU Center for Evidence Based Practice and Research, A Collaborating Center of the Joanna Briggs Institute, Texas Christian University, Fort Worth.

L.R. and S.M.W contributed equally as second authors.

The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

© 2014 National Association of Orthopaedic Nurses