Background: In a special report published in 2015 by the American Geriatrics Society (AGS), a postoperative delirium expert panel was chosen and gave recommendations for best practice for the reduction of delirium. The Institute of Medicine supported the following ten behavioral and nonpharmacological strategies for prevention of delirium:
1. Sensory enhancement (ensuring glasses, hearing aids, or listening amplifiers)
2. Mobility enhancement (ambulating at least twice per day if possible)
3. Cognitive orientation and therapeutic activities (tailored to the individual)
4. Pain control with scheduled acetaminophen if appropriate
5. Cognitive stimulation (if possible, tailored to the individual’s interests and mental status)
6. Simple communication standards and approaches to prevent the escalation of behavior
7. Nutritional and fluid repletion enhancement
8. Sleep enhancement (daytime sleep hygiene, relaxation, non –pharmacologic sleep protocol, and nighttime routine)
9. Medication review and appropriate medication management
10. Daily rounding by an interdisciplinary team to reinforce the interventions
The best practice statement was review by both surgical and nonsurgical experts in the field of geriatric medicine and surgery and was accepted. The best practice statement is a call for change in the care of post-operative patients 65 years and older. The AGS Geriatric for Specialist Initiative (AGS-GSI) recognized delirium as the most common surgical complication in older adults, occurring in 5% to 50% of older patients after an operation. In the United States more than one-third of inpatient surgeries are performed on patients 65 years or older (Hall & DeFrances, 2010) making it imperative that clinicians caring for surgical patients understand optimal delirium care. Delirium is a serious complication for older adults because an episode of delirium can begin a cascade of deleterious clinical events, including other postoperative complications, prolonged hospitalization, loss of functional independence, and reduced cognitive function and death (Robinson & Raebirm, 2009). Cost to patients includes impact on long-term cognitive ability and loss of preoperative quality of life. Furthermore, cost to the health care system is estimated at $150 billion annually (Leslie & Marcantonio, 2008). This proposal will examine the implementation of the eighth recommendation which is the behavioral and nonpharmacological strategies for prevention of delirium; sleep enhancement with the introduction of a best practice sleep hygiene protocol (appendix I).No embarg
