Nursing Home Quality Improvement Initiative
Quality Measure Fact Sheet:
Percent of Short Stay Residents with Delirium
What this means:
This measure reflects the percent of short stay residents who have symptoms of delirium. Delirium is an acute or sudden state of confusion that involves a significant decline in alertness and level of functioning. The condition develops relatively quickly and is a sign that the resident is in need of quick medical attention. Delirium is not dementia, and is a result of a medical condition or medication.
Signs/symptoms of delirium:
- Changes in behavioral such as incoherent or disorganized speech (e.g., rambling from subject to subject, nonsensical speech);
- New periods of restlessness such as picking at skin or clothing, repetitive physical movements or frequent change in position;
- New periods of lethargy such as staring into space and not moving for long periods;
- New periods of altered perception such as talking to someone who is not present, or believing that they are somewhere else; and
- Varying mental function throughout the day and from one day to the next.
Why residents may be delirious despite good care:
Delirium is common in hospitalized elderly individuals due to medical illnesses and new medications. Factors associated with delirium include addition/changes in medications, infection, dehydration, use of restraints.
Medications needed before, during, and after surgery such as anti-anxiety medications, anesthetics, and pain medication can have unwanted side effects on the elderly. It sometimes takes days for these medications to clear from the body, after which the delirium will improve. Many individuals return to the nursing home after hospitalization with signs and symptoms of delirium. Others may develop delirium after initial admission to the nursing home.
The nursing home should be able to recognize an individual with delirium and address the underlying causes. Sometimes there are multiple causes of delirium, making treatment more difficult. These may include organ failure in those nearing end of life, heart attack, psychiatric disorders, stroke, unwanted side effects of well intended medications, and infections that good care cannot prevent.
What conditions exclude a resident from this measure: (Risk adjustment)
Residents who are comatose, with known end-stage disease, or are receiving hospice care are excluded from this measure.
| Questions you can ask the facility if they are rated high in this measure:
- How many of the residents who have delirium were admitted into the facility with delirium?
- How does the facility identify and assess delirium in a timely fashion, especially in those coming from the hospital?
- How does the facility ensure that a doctor or other healthcare professional such as a nurse practitioner is involved in diagnosing and managing delirium?
- How does the facility investigate factors that may contribute to delirium in its residents? For example, how does the facility monitor fluid balance and side effects of medications?
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