In an effort to raise awareness and encourage the engagement of patients, families, health care providers, and the public, the National Patient Safety Foundation (NPSF) has designated March 8-14 as Patient Safety Awareness Week. This year’s theme, “United in Safety,” stresses patient engagement and emphasizes the importance of the relationship between providers and patients and their families.
The ultimate health care experience can best be achieved when patients take an active role in their treatment by communicating with their health care team and always asking questions.
“While that is the goal, it isn’t always possible, for example, when an elderly patient is suffering from hospital-related delirium,” said Dr. Doug Salvador, vice president of Medical Affairs in the Division of Healthcare Quality at Baystate Health. “In those cases, it’s best to have a family member or close friend to serve as your advocate….someone you trust who can ask those questions, take notes for you, and listen to what the doctors and nurses are saying.”
What is delirium?
Delirium is a severe case of mental confusion. It is often temporary. But if it is not addressed, it can lead to long-term impaired cognition, postoperative complications and longer hospital stays.
According to Dr. Rebecca Starr of the Geriatrics, Palliative Care & Post-Acute Medicine Division at Baystate Medical Center, it is estimated that delirium can affect as many as half of the elderly patients in a hospital, especially those undergoing surgery, who are hospitalized in the intensive care unit, or who have preexisting dementia.
It can be caused by a number of factors such as medications like pain killers or sedatives, infection, dehydration, isolation and poor nutrition.
According to Dr. Starr, studies have shown it is possible to sometimes prevent delirium in elderly hospitalized patients. She said family members and caregivers can help reduce someone’s risk of developing it by:
- Making sure caregivers are getting the patient out of bed and walking him or her several times daily. If the patient is able to walk safely with your assistance, take short walks with him or her in the hallway. Also, talk to caregivers about the use of any physical restraints, which may contribute to delirium.
- Bringing in a clock to the room if there isn’t one, as well as a visible calendar, so the patient doesn’t lose track of time and become disoriented.
- Making sure the patient has access to their hearing aids and eyeglasses, which are especially important when engaging them in word games, reading and other activities to maintain cognition and avoid disorientation.
- Keeping the patient hydrated because dehydration can contribute to delirium. Ask hospital staff to keep the water pitcher filled so, if not limited to how much they can drink, he or she can drink up to six glasses of water daily. If they aren’t drinking, encourage them to drink along with you when visiting. Consider, with permission of staff, bringing in special sodas, juices or other beverages the patient enjoys.
- Asking staff to create a positive sleep environment by minimizing waking the patient for things such as checking blood pressure or temperature or drawing blood. Many things can interfere with sleep while in the hospital from noise to pain. Talk with hospital staff about other ways to help the patient sleep, rather than using sleeping pills, which can contribute to delirium in elderly patients.
- Reviewing the hospitalized patient’s medications with doctors. Many prescription drugs – from narcotics to cardiac medications – can contribute to delirium.
Staff on the Springfield 3 medical unit at Baystate Medical Center recognize that being removed from one’s home surroundings can be disorienting. They're striving to create a healing environment for their patients by participating in a pilot project to improve outcomes for older patients.