.

Evidence Based Practice and Nursing Research

June 2012

Elizabeth Card, RN, CPAN, CCRP
Lead Research Nurse Coordinator
Research Nurse Specialist IV
Anesthesiology Research Division

Elizabeth was awarded the 2012 Research and Evidence-Based Practice Award. 

Type of project:  Research/Quality Improvement
Title of project:  Assessing for Delirium in the PACU
Nurse sub-investigators:  Christina Tomes, RN; Cathy Lee, RN, CAPA, CPAN, CCRN, BSN; Lisa Allen, RN, BSN; Donna Nelson, RN, CAPA; and Jeannie Wood, RN, BSN
Description of your project:  The project proposes to identify the prevalence and risk factors for emergence and post-anesthesia care unit (PACU) delirium in adults undergoing surgical procedures.  The principle investigator and the sub-investigator are nurses; Drs. Pandharipande and Hughes serve as mentors for the project.  The five PACU nurse sub-investigators completed training on Good Clinical Practices (CITI training), and were trained to assess patients for delirium using the CAM-ICU.  There were 400 patients enrolled and evaluated for delirium on admission to the PACU, at 30 minutes, 60 minutes, and at discharge.  Demographic and risk factor data were collected.  The data from this project is currently being analyzed.
Why you chose your project:  Delirium is a form of acute brain dysfunction with reported prevalence between 16-80% depending on patient population.  Delirium is associated with longer hospital stays, increased re-admissions, poor cognitive and functional outcomes, and increased mortality.  The current definition for emergence delirium in literature is agitation upon emerging from anesthesia.  This agitation could potentially be due to a number of things (pain, fear, nausea).  From previous studies we have been involved in, many patients who are suffering from delirium have the non-agitated hypoactive subtype of delirium.  Additionally, prior studies evaluating delirium in the PACU have not utilized a validated tool for delirium diagnosis and have focused on hyperactive delirium, likely under-diagnosing the hypoactive subtype.  The CAM-ICU is a validated and well-published tool that allows for rapid diagnosis of hyperactive and hypoactive delirium by bedside nurses and may be used with intubated patients.  This was a perfect fit for the PACU patients as a few were still intubated, and most had recently been intubated.
Future plans:  A project to focus on larger populations to identify additional risk factors, in addition to examining cognitive, functional, and clinical outcomes related to emergence or PACU delirium.

Publications information:
1.)  Abstract is published in American Delirium Society meeting proceedings - June 3-5, 2012
2.) Manuscript to be written and submitted to appropriate peer reviewed journal by the investigators

If you have any questions regarding Elizabeth's project please email her at Elizabeth.B.Card@Vanderbilt.edu.

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