b'NURSING HIGHLIGHTS 2022ACUTE DELIRIUM MANAGEMENT: Preventing Brain FailureDana BissonRN, MSN I CLINICAL IMPROVEMENT SPECIALIST PROFESSIONAL PRACTICE AND DEVELOPMENTGeorge* was admitted to the observation unit for severe bleeding on aThese patients are unable to participate in their own treatment blood thinner, hypotension and syncope requiring blood transfusions.plansresulting in increased complications, increased workload He was being frequently monitored and assessed, but was otherwiseof staff, and longer lengths of stay. Delirium is independently stable and was baseline cognitively intact. After several inpatient daysassociated with increased mortality and morbidity (Figure 1, he became extremely confused and was hallucinating and repeatedlyAmerican Heart Journal, 2015)even years after discharge fromTRANSFORMATION jumped out of bed. He wasnt able, in his confused state, to understandthe hospital (Figure 2, BMJ Open, 2015). the instructions of staff, safely mobilize or get needed rest, and this sudden change was terrifying for his wife to witness.FIGURE 170Martha* had been lifted to the chair in her room, breakfast tray60CICU Mortality (Global Chi-Square) CICU Mortality (Global Chi-Square)untouched yet again. She was completely unaware of her surroundings,70and not responding to staffs attempts to communicate with her.50 60Martha had not been able to even stand up during this admission due40 50to severe inattention and awareness. 30 40Elizabeth* was admitted with a cervical fracture from a fall and severe3020baseline dementia. She was extremely confused, at times combative,20and kept trying to get up without assistance. Eventually, Elizabeth had10 10to be placed in mitts, as she kept trying to remove her cervical collar. 0 0Acute Respiratory Acute Respiratory Acute RespiratoryAcute Respiratory Acute Respiratory Acute RespiratoryFailure e FailureeFailure Failur Failur Failure Delirium can be described as sudden, reversible, brain failureAcut +enal +enale R AcutAcute Renal Acute R e RenalFailure Failure Failure Failure caused by an acute illness, injury, surgery or medication adjustment. DeliriumTraditionally, management of delirium has centered on providingFIGURE 2 Deliriumconsistent preventative measures, early identification, and45aggressive treatment of all underlying causes and illnesses. Despite45 40this aggressive, meticulous management, delirium is still incredibly40 35Mortality Risk (%)common and patients experiencing delirium continue to have poor35 30Mortality Risk (%)outcomes worldwide.30 2520251520Delirium continues to be the 15 10 0100200 300 400 500 600 700510 0greatest independent5 Days from Admission0predictor of Many patients with severe delirium never return to thei7000100200 300 400 500 600 r normo-Days from Admissioncognitive state once the acute phase of delirium has passed patient outcomes. (New England Journal of Medicine, 2013). A serious barrier to mitigating these harms is the absence of a specific treatment forthe phenotype of delirium itself. (cont.)29'