1. Reducing the Risks of Delirium- From the Field to the Hospital SUSAN SCHUMACHER, MS, APRN-BC

2. What is Delirium? Acute, fluctuating disturbance of consciousness, attention, cognition, and perception, that can affect sleep, psychomotor activity, and emotions. ◦(Allen,KR., Fosnight, SM et.al, 2011)

3. Incidence and Outcomes Related to Hospital-Acquired Delirium 2.3 million Americans develop delirium every year 5-61% of orthopedic patients annually; hip fracture patients highest incidence 18% of patients who develop delirium do not have resolution 6 months after discharge 50% of patients die within 1 year

4. Risk Factors for Developing Delirium  Dementia, Parkinson’s Disease, past delirium  Pain  Sensory Deficits (macular degeneration, hearing loss)  Medications (polypharmacy and/or certain drugs)  Hypoxia  Sleep deprivation  Dehydration (fluid/electrolyte imbalance)  Nutritional status  Infections

5. What’s the Role of EMS personnel? If patient has Sensory Deficits: ◦Bring glasses and/or hearing aids to Emergency Center ◦Encourage patient to wear ◦If family member questions why these items should be taken to hospital, please communicate the importance of patient being able to see and hear information provided by hospital staff.

6. What’s the Role of EMS personnel? Medications that increase risk of Delirium: 1. Benzodiazepines (ie., Ativan) 2. Antihistamines (ie.,Benadryl) 3. Narcotics (ie., Morphine, Demerol) 4. Hydroxyzine (Vistaril) There are appropriate uses for any of these medications for older patients, however it’s important to understand their risks in leading to delirium. Minnesota Hospital Association- LEAPT (Leading Edge Advanced Practice Topic) for Reducing Delirium