Reports About Patients Experiencing Delirium in the Hospital Have Increased

Sixty-four delirium patients suffered harm; know the risk factors and symptoms

News provided by

Pennsylvania Patient Safety Authority

Sep 16, 2015, 08:00 ET

HARRISBURG, Pa., Sept. 16, 2015 /PRNewswire-USNewswire/ -- Over 400 events of patients experiencing delirium were reported from hospitals over a 10-year period with 64 resulting in patient harm, according to the September Pennsylvania Patient Safety Advisory article released today.

Delirium is sudden confusion that comes and goes. People with delirium often have trouble thinking clearly and have difficulty paying attention. Delirium is not a disease, but is a temporary condition that can affect people of all ages. However, among hospitalized patients, it is more likely to affect older adults.

Analysis of events reported to the Pennsylvania Patient Safety Authority from January 2005 through December 2014 showed common risk factors for patients that include age 65 or older, male gender, preexisting cognitive impairment, depression and severe illness.

"Delirium should not be confused with dementia, which is a chronic condition that impairs a person's memory over time and eventually prevents them from being able to perform everyday activities," Michelle Feil, MSN, RN, CPPS, Patient Safety Authority analyst said. "In contrast, delirium is a sudden, temporary change in a person's mental state that impairs attention and can fluctuate from moment-to-moment."

"The Authority has seen a nearly seven-fold increase in the number of delirium-associated patient safety events reported over the past decade, with an average of sixteen events reported per quarter in 2014, compared with two and a half per quarter in 2005," Feil added. "This increase could represent an increase in the number of these events that are occurring. But it is probably also the result of heightened awareness and improved recognition of delirium.

"The actual number of delirium-associated patient safety events could be much higher," explained Feil. "We know that this is a very prevalent condition for older adults, and patients of all ages who are severely ill, especially patients in critical care or at the end of life. But there continue to be challenges in screening for and accurately diagnosing delirium."

Falls were the most common event type in 158 reports followed by adverse drug events (n=71, 15.9%).

Feil said other common factors that can increase the chances of a patient experiencing delirium include sudden or severe illness or medical condition (e.g., stroke, infection, substance withdrawal); certain medications (e.g., sedatives, narcotics); surgery requiring sedation; and environmental factors (e.g., sleep deprivation).

"Many serious outcomes have been associated with delirium, including increased morbidity, length of hospital stay, healthcare costs, institutionalization and higher death rates – even up to a year following the initial episode," Feil said. "The risk for poor outcomes increases when delirium goes undetected and untreated, which estimates say happens in one-third to one-half of all cases."

Feil added that evidence-based guidelines and risk reduction strategies are available to help identify and prevent delirium in patients.

"The Authority has given healthcare providers a list of diagnostic and preventive measures to help identify, prevent and treat hospital-acquired delirium, Feil said. "Consumer tips have also been developed to help caregivers and patients know more of what to look for and expect in regard to delirium symptoms, preventative measures and treatment."

The Advisory and consumer tips also provide a graphic that shows other factors that can trigger delirium that were most frequently identified in reports to the Authority. This graphic is also available as a stand-alone poster on the Authority's website.

"It's important for healthcare providers and caregivers alike to understand and know the risk factors for delirium," Feil added. "Our data, along with national data, shows the need for more awareness to be brought to this condition that can cause patients harm."

For more information about delirium and how to prevent, diagnose and treat it, go to the September Pennsylvania Patient Safety Advisory article, "Delirium: Patient Safety Event Reporting and Strategies to Improve Diagnosis, Prevention and Treatment," at www.patientsafetyauthority.org. Consumer tips can also be found at the Authority's website by clicking "Patients and Consumers" on the left hand side.

Other highlights of the 2015 September Advisory include the following:

Medication Errors Affecting Pediatric Patients: Unique Challenges for This Special Population: From January 2013 through October 2014, 4,065 medication errors involving pediatric patients were reported to the Authority. Almost 18% of the reported events reached the patient and either required additional monitoring to preclude harm or caused actual harm. When looking at the age ranges of patients involved in the events, 28.1% of the reports involved neonates and 60.2% involved patients younger than five years of age. Important risk reduction strategies include dispensing medications for individual patients in a patient-specific, ready-to-administer form whenever possible and ensuring ready access to appropriate and current clinical information about patients.
Pregnancy-Related Unplanned Returns to the Operating Room: Hospitals, ambulatory surgical facilities, birthing centers and abortion facilities reported 8,569 events to the Authority from January 2010 through December 2014 involving pregnant women. Of these reports, 1,031 involved an unplanned return to the operating room. These events most frequently occurred either at the beginning of pregnancy (generally related to termination of a pregnancy) or in the immediate postpartum period. This article discusses how organizations that have implemented evidence-based systematic protocols and simulation-based education have reported better patient outcomes.
The Current State of "Wrong Patient" Insulin Pen Injections: Thousands of patients in the United States have received injections from potentially contaminated insulin pens, typically involving inappropriate or unrecognized sharing of a patient's previously used pen device. The Authority found 82 reports of potential or actual wrong-patient errors with the use of insulin pen devices in Pennsylvania from 2005 through 2014. Despite widespread media coverage, recommendations from national organizations, and application of strategies considered best practices, wrong-patient insulin injections continue to occur. Hospitals are encouraged to analyze their own wrong-patient events with the use of insulin pens and examine their current insulin practices as they decide whether to use insulin pens, vials, or a combination of the two. This article also is accompanied by updated consumer tips and educational toolkit available on the Authority's website.
Antimicrobial Therapy for Pneumonia in Pennsylvania Long-Term Care: A Spotlight on Culture: In the United States pneumonia is responsible for an estimated 60,000 deaths annually of people aged 65 and older and is the fifth leading cause of death within this population. Because of the prevalence of pneumonia, antibiotics are widely prescribed and administered in the long-term care (LTC) community. To gauge the extent of culture-guided antimicrobial therapy for pneumonia in Pennsylvania LTC facilities, Authority analysts queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) database. The percentage of LTC residents who received antibiotics for pneumonia in the absence of culture data ranged from 85.2% to 91% across Pennsylvania regions. This article discusses the pressing need to attempt to collect culture data, rather than relying on empiric treatment algorithms, in order to tailor treatment to a specific pathogen as often as clinically possible.
Quarterly Update on Wrong-Site Surgery: Eleven Years of Data Collection and Analysis: This article provides a summary of the Authority's wrong-site surgery project. A wrong-site surgery educational toolkit is available.