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Drexel University
DNP Student

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Background:

Delirium is a potentially lethal condition and is often missed in diagnosis in the emergency department (ED) setting.  There have been a number of poor outcomes associated with missed delirium in the ED including mortality, decrease in function and cognition, and increased healthcare spending.  Targeted education and the use of a standardized screening tool is an effective strategy in mitigating this clinical practice problem.

Purpose:

The purpose of this performance improvement project is to improve recognition of delirium in the elderly in order to improve outcomes related to the missed delirium diagnosis in the ED setting.

Setting:

The proposed project will take place at Trinitas Regional Medical Center, Elizabeth, N.J. in a newly renovated Geriatric Emergency Department.

Implications:

This evidence based practice change will be a priority as the organization begins to utilize processes for a newly renovated geriatric emergency department.  It will improve the safety and efficiency in the care delivery of the elderly in the emergency setting.

Keywords: Delirium, Elderly, Emergency Department

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This course has provided an added layer of depth to the critique of quantitative evidence.  It has provided a broader understanding of quantitative research design and the strengths and inherit flaws that come with each design.  The strategy developed within the course to systematically evaluate the research design, sampling design, measurements and data analysis of each article will be valuable in revising with great detail each piece of evidence to be used during the implementation of this DNP performance improvement project in the future.

It is important to note that throughout this course I found each publication previously chosen to be included into the table of evidence had weaknesses in various portions of the design.  This may be due to various reasons including poor study planning or the restrictions from the editor for the journal on word count etc.  Regardless of the etiology of the missing “pieces” of each publication the critique of the evidence became much more robust through the systematic evaluation used.

Future revisions of the table of evidence will include more specific critiques based upon the knowledge acquired in this course.  One area identified as being specifically deficient in my current table of evidence is the critique of the data analysis for each article.  This will be an area of focus for me in the future revisions to the table of evidence.  As this DNP project continues to evolve and the search strategy based upon the interventions is refined, with the aid of my project mentor and chair, there will be an additional column added to the table of evidence exploring the measurement techniques in the study.  This was neglected in the initial development of the table.

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Demystifying the confusion over delirium screening in the ED...... The EBP Journey.

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1.To provide a brief overview of the proposed performance improvement project.

2.To identify revisions to the Table of Evidence based upon the completion of this course.

3.To describe the Evaluation plan for the project implementation

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The strength of your evidence yield starts with a refined  search strategy.  The evaluation of the evidence requires rigor and attention to detail.  The use of an evidence table with adequate critique and the use of a CAT will ensure the best possible evidence is available for implementation.
The current table of evidence will be updated with the rigorous detail provided throughout this course. The current table of evidence consists of 12 articles. This will be further refined as indicated in the "Evidence Table Revisions" in this E- Poster. As new evidence is found through the refined search strategies (or new evidence generation) the table will be updated with focus on design, sampling, data analysis and a new column will be made for evaluation of measurements.

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I enjoy Advocating for our most vulnerable asset - the elderly.