Hip Fracture - Quality Statement 10: Screening for and Managing Delirium

Resources Quality Statements Advisory Committee About

Screening for and Managing Delirium

Patients with hip fracture are screened for delirium using a validated tool as part of their initial assessment and then at least once every 12 hours while in hospital, after transitions between settings, and after any change in medical status. Patients receive interventions to prevent delirium and to promote recovery if delirium is present.

Background

Patients who have experienced a hip fracture are at risk for developing delirium. Hip fracture patients with delirium are more likely to have a longer hospital stay, fall, develop pressure sores, and die than those without delirium. If delirium develops, it is important to identify and manage the underlying cause or combination of causes and to attempt to treat the delirium. Interventions to prevent delirium and to promote recovery from delirium include orienting the patient to person, place, and time (involving family, caregivers, and friends when possible); creating an environment that provides context (e.g., with a window or clock) and contains familiar items, such as pictures or personal belongings; ensuring patients are using their glasses or hearing aids as appropriate; speaking to patients in a calm, reassuring voice; and considering alternatives to or the more judicious use of drugs that may either cause or exacerbate delirium.

What This Quality Statement Means

For Patients

You should be assessed for delirium (confused thinking and reduced awareness) while you’re in the emergency department and twice a day while you’re in the hospital, after any move to a new setting, and if there is a change in your medical status.

For Clinicians

Screen your hip fracture patient for delirium during their initial assessment and prior to the administration of pain medication and surgery. Perform subsequent delirium screenings at least once every 12 hours while the patient is in hospital, after transitions between settings, and upon any change in medical status. It is important to attempt to prevent delirium by orienting your patient to person, place, and time (involving family, caregivers, and friends when possible); creating an environment that provides context (e.g., with a window or clock) and contains familiar items, such as pictures or personal belongings; ensuring that patients are using their glasses or hearing aids as appropriate; speaking to patients in a calm, reassuring voice; and considering alternatives to or the more judicious use of drugs associated with delirium.

For Health Services

Ensure that your facility has validated delirium assessment tools and a policy or protocol in place for preventing and managing delirium.

Quality Indicators

Process Indicators

Percentage of hip fracture patients who are assessed for delirium with a validated tool within 8 hours of arrival at hospital

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture
Numerator: number of people in the denominator who are assessed for delirium with a validated tool within 8 hours of first arrival at any hospital
Data source: local data collection

Percentage of hip fracture patients who are assessed for delirium with a validated tool after a change in medical status

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture who experience a change in medical status
Numerator: number of people in the denominator who are assessed for delirium with a validated tool every 12 hours
Data source: local data collection

Percentage of hip fracture patients who are assessed for delirium with a validated tool after transitioning to a new medical setting

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture who are transitioned to a new setting
Numerator: number of people in the denominator who are assessed for delirium with a validated tool every 12 hours
Data source: local data collection

Percentage of hip fracture patients who are assessed for delirium with a validated tool every 12 hours while in hospital

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture
Numerator: number of people in the denominator who are assessed for delirium with a validated tool every 12 hours while in hospital
Data source: local data collection

Structural Indicator

Percentage of hospitals that have a policy or protocol in place to prevent and manage delirium

Data source: Regional and/or provincial data collection method would need to be developed

Evidence to Improve Care