b'NURSING HIGHLIGHTS 2022In the course of working with these delirious patients at Concord Hospital, a standardized nursing intervention focusing on the phenotype of delirium was discovered and is being refined. Nurses have found an effective intervention which reverses inattention and increases awareness in patients experiencing acute delirium. Once positive results were discovered on a case-by-case basis, a Kaizen team of specifically trained nurses and LNAs throughout the organization came together to develop an innovative treatment plan that is nurse-driven. The new standard work consisted of initiating a two-step intervention, done four times throughout the day, once a patient is screened positive for delirium using the Stanford Proxy Test for Delirium (S-PTD), a standardized screening tool. The first part of this intervention, Attention and Awareness Through Movement (AATM), engages cranial nerves and stimulates the sensory and motor pathways of the Ascending Reticular Activating System. This allows for increased attention and awareness of the patient suffering from delirium so they can more fully engage in their treatment plan.able to follow commands and actually safely stand with assistance. It was discovered to work best when the bedside staff have beenOnce standing, she began looking around and said, I have a chest well-trained, and the AATM is done with intention: movements aretube? This was something the staff had been trying to explain to exaggerated, and held for at least three to five seconds. ImmediatelyMartha but she had not been able to understand or focus. Staff then following the AATM, the patient is then Mobilized To Capacity (MTC).discussed why she had it and she asked some good questions. When This reinforces the mind/body awareness, as well as physicallyMartha sat back down, she stated, Im starving! She had not had improving patient functioning through touch and movement. Themuch of an appetite the last few days, but now that she was aware two steps together are the AATM-MTC direct delirium intervention. of the sensations in her body, she could recognize and articulate her hunger. She gobbled up a chocolate ice cream before her second The morning after George became confused, one of our nursing staffbreakfast tray arrived. She could now participate in her care and shelearned of his delirium. She was not his assigned nurse, but went right felt like herself again.to work performing the AATM-MTC. Within three to four minutes, Georges confusion resolved completely. He was able to converseElizabeth was initially thought to be at baseline, with her difficulties normally, ambulate safely, and follow all commands. Later ondue to her existing dementia, but she screened positive on theThese initial real-world results raise the tantalizing possibility that specific reversal of delirium may not only be feasible ,but also safe and inexpensive .that morning, George again showed signs of confusion. The nursestandardized delirium screening tool (S-PTD). TheAATM-MTC repeated the AATM-MTC intervention and Georges delirium resolvedprotocol was initiated and within minutes it was as if she became a within two minutes. The second time completely cleared his mentalcompletely different person. She was cooperative, conversive, and able state and he didnt have issues again for the duration of his stay. to participate in care, despite her dementia; it was actually overlying George was discharged home as planned, with full cognitive function.delirium that had caused her extreme confusion.His wife was astounded to see the immediate effect of the intervention and his return to normal cognition. As the AATM-MTC was implemented in various units of the hospital, nurses were witnessing patients inattention and decreased After Martha ignored her breakfast, the AATM was performed. She wasawareness improve. Feedback from staff was that the acute delirium able to immediately become more alert and engaged. She wasintervention helped our sleepy, hypoactive delirious patients a lot. P E O P L E | I N T E G R A T I O N | T R A N S F O R M A T I O N30'