Hospitalized Older Adults With Established Delirium: Recognition, Documentation, and Reporting
| Autor: | Paula Roe-Prior, Sonia Sandhaus, Mary Kovaleski, Margarete L. Zalon |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Referral MEDLINE Gerontological nursing Coding (therapy) Hospitals Community Documentation behavioral disciplines and activities Clinical decision support system 03 medical and health sciences Patient Admission 0302 clinical medicine Geriatric Nursing mental disorders medicine Humans 030212 general & internal medicine Psychiatry Geriatric Assessment Nursing Assessment General Nursing Aged Retrospective Studies Aged 80 and over 030504 nursing business.industry Delirium Retrospective cohort study United States nervous system diseases Hospitalization Treatment Outcome Needs assessment Emergency medicine Female medicine.symptom 0305 other medical science business Gerontology Needs Assessment |
| Zdroj: | Journal of Gerontological Nursing. 43:32-40 |
| ISSN: | 1938-243X 0098-9134 |
| DOI: | 10.3928/00989134-20161109-01 |
| Popis: | Delirium, a life-threatening complication for hospitalized older adults associated with adverse outcomes, is often underrecognized and underreported. The purpose of the current study was to analyze delirium documentation for hospitalized older adults. Charts of 34 patients, aged 71 and older with documented delirium and referral to a Hospital Elder Life Program, were reviewed. With the exception of International Classification of Diseases-9 coding, delirium was only mentioned in 12 (35.3%) charts, although descriptors potentially indicative of delirium were usually recorded. Of these, the most frequently recorded were confusion (94.1%), mental d61.8%). When nurses charted delirium descriptors, only 5.9% of their notes included physician referral. Physician responses were to order diagnostic tests and medications, usually antipsychotic or benzodiazepine agents. Of 28 patients requiring transfer to another facility after discharge, delirium was mentioned in only one transfer note. Commonly used delirium descriptors can be used for the development of natural language processing tools for clinical decision support. [ Journal of Gerontological Nursing, 43 (3), 32–40.] |
| Databáze: | OpenAIRE |
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