Faculty Collaboration Database

Improving the Validity of Nurse-Based Delirium Screening: A Head-to-Head Comparison of Nursing Delirium-Screening Scale and Short Confusion Assessment Method. Psychosomatics 2019;60(2):172-178

Date

08/17/2019

Pubmed ID

31416628

DOI

10.1016/j.psym.2018.09.002

Scopus ID

2-s2.0-85055634964 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

BACKGROUND: As part of a multicomponent delirium prevention protocol the Confusion Assessment Method (Short-CAM) was introduced to nursing as the standard delirium screening instrument on the general medical units. Despite significant educational efforts, quality monitoring revealed poor sensitivity with the use of Short-CAM.

OBJECTIVES: To compare the validity of the Nursing Delirium Screening Scale (Nu-DESC) and Short-CAM on general medical units and to explore the impact of delirium education on the successful implementation of delirium screening tools.

METHODS: In this quality improvement project, both Nu-DESC and Short-CAM were scored by nurses on 2 general medical units, per standard practice. Two blinded physician-raters determined delirium diagnosis in 192 patients on these units on 8 separate days, utilizing the Diagnostic and Statistical Manual of Mental Disorders-5 criteria as the reference standard. Sensitivity and specificity of both scales were calculated.

RESULTS: Thirty-five of 192 patients (18.2%) were suffering from delirium on the day of assessment. The Short-CAM scored positive for 3 (1.6%) patients and the Nu-DESC for 50 (26.0%) patients on the same day as the physician-raters assessment. Sensitivity and specificity were respectively calculated at 8.6% and 100% for the Short-CAM and 77.1% and 85.4% for the Nu-DESC. There was no statistical difference in sensitivity and specificity of the Nu-DESC on the units regardless of the level of preimplementation delirium education.

CONCLUSIONS: The Nu-DESC was shown to be an easy-to-deploy delirium-screening tool on general medical units with improved sensitivity when compared to the Short-CAM.

Author List

Heinrich TW, Kato H, Emanuel C, Denson S

Authors

Steven Denson MD Associate Professor in the Medicine department at Medical College of Wisconsin
Thomas W. Heinrich MD Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Delirium
Female
Humans
Male
Psychiatric Status Rating Scales
Quality Improvement
Reproducibility of Results
Sensitivity and Specificity