Enhancing Accurate Delirium Detection in Older Patients With Heart Failure: Integrating Education and an Electronic Health Record Tool for Nurses.

Abstract

Background: Detecting delirium accurately in older patients with heart failure (HF) is challenging for nurses due to difficulties in assessing baseline cognition, leading to inaccurate delirium assessment. Objective: The project aimed to evaluate the effectiveness of an educational intervention and a documentation tool in the electronic health record (EHR) to enhance delirium detection rates by up to 30% in patients over 65 years with HF. Methods: Delirium detection rates were assessed pre- and postimplementation through chart review spanning 8 weeks. The Chart-based Delirium Identification Instrument was applied to preimplementation (2023) and postimplementation (2024) data for comparison over 8 weeks. Additionally, the project included a pre-post survey to examine nurses' self-reported knowledge, confidence, and perspectives on delirium detection and management. Results: Nurses achieved a 100% detection rate by accurately identifying the sole case of delirium postimplementation. Notably, nurses accurately ruled out delirium in patients who tested negative. Additionally, they reported increased knowledge and confidence in delirium detection. Conclusions: The dual intervention of nurses' education and structural documentation support contributed to enhancing the nurses' ability to accurately identify delirium. The intervention facilitated the consistent identification and documentation of baseline cognition. The streamlined process ensured consistency and facilitated easy retrieval by nurses when completing the Confusion Assessment Method for delirium detection. Implications for Nursing: Combining nurse education and an EHR tool ensures equitable access to resources for accurate delirium detection among older patients with HF. Improving delirium detection rates helps provide targeted interventions, ultimately reducing disparities in delirium-related outcomes.