care.coach Avatar (HELP-Protocolized) for Delirium

About 21% of people admitted to the hospital in 2014 will have a post-acute episode of delirium, with an onset in an acute care setting.

For most people, symptoms of delirium resolve within 1 to 7 days, and most who do not improve within this time period require medical care for their symptoms. A minority of patients improved and did not need prolonged medical care, and no patients needed an extended course of pharmacological or medical therapy.

In older people who are admitted to hospital, symptoms of delirium will be present. If symptoms become worse, delirium may cause confusion, irritability, aggression, or even hallucinations.

There were no statistically significant differences between the two groups for the outcome measures assessed. The authors are thus unable to confirm any positive effects of post-surgery delirium or post-surgery agitation on outcome for that patient cohort. Recent findings of this study suggest that the outcome assessed did not translate into any improved post-surgery recovery for the patient population under observation.

Delirium is a state of confusion characterized by disorientation that lasts for less than 24h. It usually accompanies another underlying disease. It occurs often in seniors but also occurs in newborns. It is relatively common as about 30% of hospitalized elderly persons have at least one episode of delirium on their inpatient stay. Delirium is associated with disability, mortality and hospital admissions.\n

The study suggests that, when in recovery, patients perceive that their experiences of delirium are different to those of the recovery phase. While perceptions may influence nursing practice and research results from the study, the relationship is unclear.

The prevalence of delirium in older hospitalized patients is high as well as the proportion of inpatients who are affected by delirium. There is also a need to reduce the high mortality observed among inpatients with delirium.

The CACHA program can be used interchangeably with the standard care for the ICU without significant effect. The study has not shown any significant differences regarding the ICU stay duration, length of stay, or incidence of VAP. Although it would be difficult to change the standard care, if the CACHA program were proven to be effective the program could be recommended as part of the standard protocol. The CACHA software cannot provide the same clinical services that the standard care does and the clinical effects of the program need to be evaluated before a definite recommendation on the use of CACHA can be made.

[E-cigarette] use is the primary cause of delirium, particularly for those who have been hospitalized. Other modifiable risk factors for delirium in the hospital setting may include use of benzodiazepines, antipsychotics, alcohol, or use of sedatives or other medicines. Efforts to reduce the intake of e-cigarette products in the hospitalized setting may lessen delirium. The use of e-cigarettes has been implicated in a range of health conditions including acute cardiac events and acute pulmonary events. These preliminary findings suggest e-cigarette use increases the risk of delirium and may therefore be contributing to the growing numbers of hospitalizations around the world.

As more research emerges there will be more data in support of the use of CAV. More research in the forms outlined below will continue for at least several years to establish any more definitive information.

This case discusses the process of developing a Help-Protocol, the process of implementing protocolized care, and the impact of the Help-Protocol. This information could aid researchers or health care managers interested in implementing protocolized care, such as in older adults with multiple chronic conditions.