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Peer post, coherence, staff engagement, transparency, open communication, and leadership

Peer post, 

coherence, staff engagement, transparency, open communication, and leadership engagement are paramount for a successful intervention implementation (Giazik et al., 2021). The DNP student will be readily available to address any potential barriers during the implementation phase. Such barriers that may interrupt the implementation of the Confusion Assessment Method (CAM) project intervention is the lack of nursing support for the intervention. The nursing shortage crisis and the additional workload due to the ongoing coronavirus pandemic may cause the staff to resist the additional burden of implementing the CAM intervention. To alleviate such a burden, the DNP student, with the help of the IT department, will integrate the confusion assessment tool into the electronic medical record. Patients and their families may also be hesitant to participate due to the potential stigma related to a diagnosis of delirium. This kind of barrier can be overcome by explaining the benefit of the CAM intervention.

Implementation depends largely on the acceptance and the ease of the measuring tool by team members (Waltz et al., 2019). The DNP project manager will continue to facilitate open communication with the nurse leader and nursing staff on the unit and maintain guidelines that align with the organization’s values. The DNP student will arrange a daily huddle with staff at the beginning of each shift during the implementation phase to address staff concerns. There will be ongoing staff training through observation and auditing of the CAM. The DNP project manager invites interested nurses to be champions for the project. Waltz et al. (2019) indicated that persons who act as champions would market, support, and drive the implementation process to overcome resistance.  The implementation of the intervention aligns with the organization’s goal of patient safety.  The DNP student will capitalize on the evidence-based practice project to secure cooperation with key stakeholders by discussing the benefits of the CAM intervention on best patient outcomes, decrease in mortality, safe discharge, and quality assurance.

Outcomes

The benefit of early identification and management of delirium in hospitalized adults age 65 and older will be measured using the Confusion Assessment Method (CAM) [Inouye et al., 2009] (Appendix A).  The 9- item questionnaire is used to detect delirium in high-risk individuals based on the observation made by trained registered nurses; questionnaire # 2 has two additional questions that assist the examiner in determining inattentiveness. A nominal measurement scale is used. The diagnosis of delirium requires the presence of the first two criteria and either the third or fourth criterion [Appendix A]. The CAM screening tool has shown high consistency – Cronbach’s Alpha of 0.85 and is accepted as a valid and reliable measurement for use by researchers (Khan et al.,2017; Oh et al., 2017). The tool will be integrated into the electronic medical record and used as an attachment to the daily patient assessment used on the unit. The registered nurses will take approximately five minutes to complete the questionnaire. The implementation will take place over a ten weeks period. The first two weeks will cover the education and readiness of the implementation team. The data will be collected at the end of week nine after seven weeks of data collection. The CAM tool is in the public domain, and permission is not required.

References

Glazik, R., Moore, H., Kennedy, D., Bower, H., Rohan, H., Sharp, A., & Seale, A. C. (2021). A snapshot of the practicality and barriers to COVID-19 interventions: Public health and healthcare workers’ perceptions in high and low- and middle-income countries. PloS One16(11), e0260041–e0260041. https://doi.org/10.1371/journal.pone.0260041 (Links to an external site.)

Khan, B.A., Perkins, A. J., Gao, S., Hui, S. L., Campbell, N. L., Farber, M. O., Chlan, L. L., & Boustani, M. A. (2017). The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Critical Care Medicine45(5), 851–857. https://doi.org/10.1097/CCM.0000000000002368 (Links to an external site.)

 OH, E.S., Fong, T.G., Hsheih, T.T., & Inouye, S.K. (2017). Delirium in older persons: advance in diagnosis and treatment. JAMA, 318 (12), 1161-1174. htttps://doi.org/10.1001/jama.2017.12067

Sullivan, M.B., Rentz, A., Mathura, P., Gleddie, M., Luthra, T., Thiele, A. T., Kovacs Burns, K., Rich, R., & Sia, W. W. (2022). Establishing an alternative accommodation for stable hospitalized antepartum patients: barriers and challenges. BMJ Open Quality, 11(1). https://doi.org/10.1136/bmjoq-2021-001625 (Links to an external site.)

Waltz, T.J., Powell, B. J., Fernández, M. E., Abadie, B., & Damschroder, L. J. (2019). Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implementation Science : IS14(1), 42–42. https://doi.org/10.1186/s13012-019-0892-4 (Links to an external site.)

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