Delirium: The starting point of 100,000 Lives
Victoria’s Chief Nurse and Midwifery Officer Ann Maree Keenan takes us back to the ground-breaking research and resulting improvement initiative that started us towards 100,000 Lives.
Four years ago now, we set out on a mission to expose the delirium that was hiding on our wards. In the nursing notes describing ‘sundown syndrome’. And in data covering hospital falls, pressure injuries and occupational violence.
Despite the evidence about the impact of delirium and guidelines on management, it had remained unrecognised, misdiagnosed and under-treated.
In 2016-17, there were only 6,600 cases of hospital acquired delirium documented in patient files in Victoria - roughly 0.5 per cent of the older patient population.
So in 2018, we conducted an Australian-first survey (and one of two worldwide) to measure the real presence of potential delirium. It was a huge operation. We worked with 83 public health services and more than 400 clinicians to survey 5,500 patients screening each for delirium.
Giving us our first true sense of the problem, we found:
- 40.1 per cent of patients older than 65 years had a possible delirium
- those with possible delirium had an average age of 73 years.
It’s a big jump from 0.5 per cent to 40.1 per cent. And it makes you think of the patients who suffered undue stress, anxiety and pain, as well as their families and healthcare team.
With this improved understanding – and knowing that delirium is potentially preventable in one third of people at risk - we worked with health services on strategies to identify it early and address the underlying causes.
So rich was the evidence, so prevalent the problem and so high was the engagement with clinicians, that this became our first large-scale improvement collaborative under our partnership with the Institute for Healthcare Improvement.
The results were astonishing, with improved screening, reduced falls and fewer bed days for patients aged older than 65 years.
We also used this research to develop best practice guidance to assess patients for pain, agitation and delirium in intensive care units (ICUs). And we trialled an innovative project at Austin health to assess, prevent and manage delirium.
This early success in driving down patient harm in hospitals gave us the confidence to continue our improvement approach, and to start in this ambitious goal of 100,000 Lives.
Ann Maree Keenan is Victoria’s Chief Nurse and Midwifery Officer.